'Jtm 




Gass. 
Book 



COPYRIGHT DEPOSIT 



SEXUAL IMPOTENCE 



BY 

VICTOR G. VECKI, M. D. 

CONSULTING GENITOURINARY SURGEON TO THE MOUNT ZION 
HOSPITAL, SAN FRANCISCO 



F/F7ii EDITION, ENLARGED 



PHILADELPHIA AND LONDON 

W. B. SAUNDERS COMPANY 

1915 



6* 
3 



Copyright, 1899, by W. B. Saunders. Revised, entirely reset, reprinted, and 

recopyrighted July, 1901. Revised, entirely reset, reprinted, 

and recopyrighted April, 1912. Revised, reprinted, 

and recopyrighted December, 1915 



Copyright, 1915, by W. B. Saunders Company 



PRINTED IN AMEHIC/ 



PRESS OF 
W. 3. SAUNDERS COMPANV 

PHILADELPHIA 



DEC 27 1915 



'CU 4 18228 



PREFACE TO THE FIFTH EDITION 



Despite the brief lapse of time since the publica- 
tion of the fourth edition of this book, additions and 
a few modifications in this new edition were impera- 
tive. 

New and better instruments have made th deep 
urethra more accessible to a rational local treat- 
ment, but likewise have offered suggestions for varied 
mutilations. 

In their time the ovaries were the object of the 
' 'furor operandi," and it appears now as if the 
colliculus seminalis and the seminal vesicles must be 
substituted for them, and must be sacrificed to 
demonstrate brilliant technic. 

Proceeding from one extreme to another, one en- 
counters the beseeching demands of psychotherapy. 
That psychotherapy is new is not true, and that it 
is very often the true treatment is not new. Even 
psychotherapy for sexual neurasthenic troubles is 
nothing new. The author advocated it in the first 
edition of this book (published in 1888), when 
urology was in its toddling clothes, and at a time 
when the subject of sexual neurasthenia was strictly 
tabooed in polite medical society. 

Even a superficial study of the history of medi- 
cine will convince any one that psychotherapy was 

1 



2 PREFACE 

used at all times by the physicians of all nations. 
Fakers also, at all times, tried to take hold of 
psychotherapy, and some of them were exceedingly 
successful with many patients ; but in order to treat 
any case of disease, first of all a correct diagnosis 
must be made. No treatment of any kind should 
be entered upon before the indication is properly 
established. This being so obvious, it also proves 
irrefutably that it is either gross ignorance or a 
brazen and criminal impertinence that any one 
should have the temerity to subject a fellow human 
being to any kind of healing, mental or other, with- 
out having previously mastered the knowledge neces- 
sary to discriminate between the nature of a sick- 
ness in which mental healing can accomplish any- 
thing and other forms of diseases where different 
means must be used to protect the patient against 
suffering or even against premature death. 

The Author. 

San Francisco, California, 

Physicians Building, 

December, I9J5- 



PREFACE TO FOURTH EDITION. 



The enormous strides made during the past twenty- 
years towards a rational consideration of the many 
perplexing problems of the normal functions of the 
sexual organs and their pathology are most gratifying 
to the pioneers in this field. It is very significant 
that now even great surgeons, when removing a 
sufferer's prostate, condescend to consider the conse- 
quences to the man's sexual power. 

The lion's share in this fortunate change of front 
must be awarded to the extraordinary progress that 
modern urology has bestowed upon modern medicine. 
This youngest medical specialty, at first spurned on 
all sides, is forging its way to the front. 

Physiologists considered the urinary organs within 
the exclusive domain of internal medicine, and, 
besides, refused stubbornly to consider the functions 
of the male sexual organs. But urology broke into 
physiology and into internal medicine almost at the 
same time. The newest ally to the sexual part of 
urology appears in that great question, probably one 
of the most important that medicine ever tried to 
solve, the riddle of internal secretion. Physiology 
is compelled to join in the campaign by emphasizing 
that the sexual functions cannot be loftily ignored. 

In consequence of the interesting and important 
discoveries made by the explorers of the bacteriologic 
flora of the various sexual organs and their appen- 
dages, reinforced by the local findings made possible 

3 



4 PREFACE TO FOURTH EDITION 

by newly invented, excellent urethroscopes with 
which we can really see, even the most one-sided 
neurologists were compelled to acknowledge that 
many a neurasthenic in reality had an ampulla, a 
vesicula seminalis or two, a prostate or a verumon- 
tanum that need the urologist's help. 

In this new revision I endeavored to reflect the 
gains made by urology. The chapters on anatomy 
and physiology had to be revised and enlarged in 
order to form a proper foundation for the modifica- 
tions of our opinions on sexual neurasthenia, the 
influence of many diseases upon the sexual power, for 
our modest attempts at the understanding of internal 
secretion, of physiotherapy and for the most ener- 
getic protests against urological atrocities committed 
on the complicated and delicate structures of the 
deep urethra. 

The reader will find most of the modifications and 
additions in the chapters on the treatment of sexual 
impotence, but none in those dealing with the socio- 
logical and ethical sides of our subject; thirty years 
of experience as a physician only strengthened 
youth's "glad inheritance, the inextinguishable love 
of truth." 

The medical press of the United States, Canada, 
England and Ireland was very kind to this little 
book. I tried to heed some of the good advises 
given to me, but was unable to do so with all of them, 
some I could not, and a few I would not. 

The Author. 

San Francisco, California, 
381 Bush Street. 



PREFACE TO THIRD EDITION. 



The reading part of the medical profession in the 
English-speaking countries has pronounced judg- 
ment upon this monograph. The verdict is highly 
gratifying to the author. The first American edi- 
tion was exhausted in less than two years. The 
comments of the medical press were almost without 
exception favorable. True, one anonymous critic 
was rather harsh, but the sting from his pen has been 
removed by the queer coincidence that the publish- 
ers of the paper which gave room to his assault 
offered in 1898 to publish my work. The critic him- 
self is naive enough to admit that the handling of 
some phases of the question will be misunderstood, 
and we agree with him, as evidently he is a fair ex- 
ample of those few who misunderstood the book 
altogether. 

May this new edition meet with the same success 
as the previous ones, and without a murmur we shall 
endure if it meets with the same enemies. 

The Author. 



PREFACE TO THE FIRST AMERICAN 
EDITION. 



When the first German edition of this work was 
published, in 1889, there was some commotion in the 
ranks of old and young medical fogies, who were in- 
dignant that any one dared to resist their intellectual 
tendencies, refused to worship their superannuated 
gods. 

The second German edition found the ranks of the 
same kind of professional formula-riders and bigots 
solid, though somewhat thinned. 

I have taken the liberty of preserving the indepen- 
dence of my altruistic opinions, and shall continue 
to fight against false and hypocritical quasi-scientific 
pretentions. The circumstance that my work has 
been given earnest consideration by authorities like 
Casper, Eulenburg, Fiirbringer, Krafft-Ebing, and 
others makes it easy to bear all the acrimonious 
aggressions dictated by the bilious nature of some of 
the " Dii minorum gentium." 

I wish to thank Professor A. A. D'Ancona, who 
kindly revised the manuscript and helped me in 
many other ways. 

The Author. 



PREFACE TO THE SECOND GERMAN 
EDITION. 



In the lapse of seven years passed since the publi- 
cation of the first edition of this work, we can record 
but very little progress in the theoretic as well as the 
practical development of our subject. We know to- 
day just as much — or, better, just as little — about 
the physiology of the sexual act as we did seven 
years ago. 

Quite new, indeed, is an abundance of newly* : 
forged names for old pathologic conditions. Some 
authors try to perpetuate themselves in this way. 
We can only hope that most of these new names will 
be short-lived. 

The therapeutics of sexual impotence has received 
some valuable additions, and we have in the method 
of suspension a frequently efficacious, and in hypno- 
tic suggestion an occasionally efficacious, remedy. 

It affords me special satisfaction that my mono- 
graph has not proved to be an ephemera, in spite of 
the many adversaries the liberal interpretation of 
some pertinent questions has encountered. 

The Author. 

San Francisco, California, 1896. 



PREFACE TO THE FIRST GERMAN 
EDITION. 



To write on the much-scouted subject of sexual 
impotence is a venturesome undertaking under all 
circumstances; but to write without the customary 
affectation and without any hypocritical excuses, to 
speak the bare truth, surely requires even greater 
courage. Many an eminent medical man may have 
felt a secret desire to take the risk, but refrained 
from carrying out the resolution through fear of en- 
dangering his professional reputation. Some one 
not counted among the magnates of the medical 
realm may feel licensed to plunge to the very bot- 
tom, "to see what the gods have covered with dark- 
ness and horror," and may dare to relate to his col- 
leagues what he sees and hears, without alteration 
or retouching. 

"No physical or moral suffering, no wound, how- 
ever putrid it may be, should frighten him who de- 
votes his life to the science of man; and the sacred 
ministry which obliges the physician to see every- 
thing, to know everything, gives him also the right 
to relate everything." 1 

It must be admitted that the subject has never 

1 Tardieu Etude medico-legale sur les attentats aux moeurs. 
Paris, 1878, p. 2. 

8 



PREFACE TO THE FIRST GERMAN EDITION 9 

received the attention its preeminent importance de- 
serves. Everywhere in the world it seems to be con- 
sidered the proper thing to treat the affair with super- 
cilious nonchalance. Few medical men in Germany 
can boast of ever having had an opportunity to hear 
a clinical lecture on sexual impotence ; and the com- 
plaints and criticisms of authors prove that else- 
where the question receives no greater attention. 
"The subject is thus not yet emancipated from the 
tenacious grasp of the most rampant charlatanism." 1 

"Let us be frank from the first steps of our re- 
searches, because hypocrisy is the worm which in 
modern society attacks and corrodes the highest and 
most powerful plant of this life's garden." 2 

This somewhat serious neglect is no doubt to be 
attributed to the circumstances that those suffering 
from impotence can hardly be subjects for treatment 
in hospitals, and that the observation of the details 
and symptoms of the disease is attended with un- 
usual difficulties; nay, is hardly possible at all. 

Recent indications seem, however, to point to a 
better future. Men of prominence in the learned 
world, with Eulenburg, Krafft-Ebing, Fiirbringer, 
Edw. Martin, Lydston, Sturgis, and some others at 
the head, do not think it beneath their dignity to 
busy themselves with the solution of the perplexing 
problems of the sexual life, and it is to be hoped that 
before long the conventional medical lies with which 
every book, every pamphlet on the subject is swarm- 

1 Campbell Black, On the Functional Diseases of the Urinary 
and Reproductive Organs. London, 1875, p. 6. 

2 Mantegazza, Fisiologia deH'amore. Milano, 1882, p. 75. 



IO PREFACE TO THE FIRST GERMAN EDITION 

ing, will disappear and Mantegazza's satire 1 become 
obsolete. 

" Difficult problems cannot be solved if we run 
away from them or if we avoid them ; and still many 
a physician, many a philosopher, tries to solve the 
most burning questions of modern society in the 
manner of the baby who believes he can escape the 
threatening dog by closing his eyes." 

Vecki. 

1 Op. clt., p. 298. 



CONTENTS 



CHAPTER PAGE 

Introduction 17 

I. — Anatomy. 30 

II. — Physiology of the Sexual Act 50 

Sexual Maturity 50 

Sexual Orgasm 52 

Seat of the Sexual Instinct 56 

Erection 57 

Ejaculation 62 

The Semen 64 

III. — Etiology of Impotence 87 

IV. — Forms of Impotence 96 

Congenital Malformations and Defects of the Sexual 

Organs 96 

Absence of Penis 97 

Diminutive Size of Penis 97 

Excessive Size of Penis 98 

Defective Erectile Tissue 98 

Narrowness of the Orificium Externum Urethrae 98 

Absence of Prepuce 99 

Superfluity of Prepuce 99 

Hypospadiasis 101 

Epispadiasis 101 

Monorchis 101 

Cryptorchis 101 

Hermaphrodites 103 

Acquired Defects in the Organs of Generation 103 

Absence of Penis and Testicles 103 

Absence of Testicles 104 

Absence of One Testicle 112 

Hydrocele and Inguinal Hernia 112 

Changes in the Corpora Cavernosa 112 

Consecutive Impotence 114 

Acute Diseases 114 

Phthisis 115 

Chronic Diseases 116 

11 



12 CONTENTS 

CHAPTER PAGE 

Autointoxication ' 1 16 

Oxaluria 117 

Diabetes 117 

Obesity 118 

Nephritis 118 

Anemia 119 

Severe Cold 119 

Disease of the Nerve x\pparatus 120 

Diseases of Brain and Spinal Cord 121 

Neurasthenia 122 

Diseases of the Genitalia 129 

Gonorrhea 131 

Prostatitis 131 

Diseases of the Urinary Bladder 138 

Strictures 138 

Lesions of the Verumontanum 140 

Painful Ejaculation 142 

Tuberculosis of the Testicles 143 

Varicocele 144 

Cavernositis 144 

Internal Secretion 145 

Alcohol 147 

Coffee, etc 150 

Tobacco 150 

Snuff-taking 151 

Digitalis 152 

Morphin, etc 152 

Arsenic 153 

Lead 154 

Iodin 155 

Mercury 155 

Salicylic Acid, Antipyrin, etc 155 

Bromo-seltzer 157 

Thyroidin 157 

Suprarenal Preparations 157 

Heroin 157 

Inherited Predisposition to Impotence 158 

Sexual Weakness 158 

Incontinence of Urine 160 

Frigidity 162 

Nervousness 163 



CONTENTS 13 

CHAPTER PAGE 

Perverse Sexual Feeling 165 

Neurasthenic Impotence 176 

Excess in Venery 1 78 

After-effects of Copulation 190 

Sexual Excesses, Consequences of 193 

Frigidity 195 

Satiety of Ordinary Sexual Gratification 196 

Paralytic Impotence 198 

Priapism 204 

Onanism 205 

Causes of Onanism 210 

Consequences of Onanism 217 

Nervous Diseases 218 

Pollutions and Spermatorrhea 221 

Endoscopic Examination, Results of 233 

Continence 236 

Irritable Weakness 242 

Psychical Impotence 246 

Temporary Impotence 249 

Relative Impotence 250 

Professional Impotence 253 

Senile Impotence 257 

V. — Diagnosis 263 

VI. — Prognosis 269 

VII. — Prophylaxis 272 

Prevention of Gonorrheal Complications 281 

VIII. — Treatment 291 

Psychical Treatment 293 

Removal of Morbid Influences 294 

Hypnotic Treatment 295 

Freud's Psycho-analysis 297 

Treatment of Spermatorrhea 308 

Hygiene of Living 317 

Nourishment 317 

Sleep 321 

Medicaments 321 

Aphrodisiacs 322 

Cantharides, etc 324 

Phosphorus 324 

Nux Vomica 325 

Brucin 326 



14 CONTENTS 

CHAPTER PAGE 

Atropin 326 

Secale Cornutum . . 326 

Ergotin 326 

Quinin . . . 326 

Iron 326 

Narcotics 327 

Valerian 328 

Stimulants . ' 328 

Cocain 328 

Scincus Marinus 328 

Damiana . 329 

Yohimbin 329 

Muiracithin 335 

Hydrotherapeutics 336 

Ablutions 339 

Friction and Similar Proceedings 339 

Sponge-baths 339 

Douches 339 

Sitz-baths 339 

Half -baths 341 

Vapor-baths 341 

River- and Sea-baths 341 

Balneological Treatment 342 

Psychrophor 342 

Injections 343 

Carbon Douche and Carbonic-acid Baths 344 

Electro-therapeutics 344 

Galvanic Current 345 

Faradic Current 347 

Static Electricity 347 

Hydro-electric Bath 348 

Local Treatment 348 

Cauterization 348 

Astringents 353 

Intravesical Irrigations 354 

Bougies and Sounds 354 

External Applications 356 

Echinacea Augustifolia 356 

Sinapisms 356 

Acupuncture and Electropuncture 357 

Surgical Operations. 357 



CONTENTS 15 

CHAPTER PAGE 

Massage and Gymnastics 358 

Horseback Riding 359 

Motorcar Speeding 359 

Traveling 361 

Flagellation 361 

Abrams' Concussion 362 

Apparatus and Instruments 362 

Regulation of the Sexual Life 370 

Matrimony 372 

Inhalation of Oxygen 375 

Suspensions 376 

Brown-Sequard's Liquor Testiculorum 379 

Organotherapy 379 

IX. — Special Therapeutics 383 



Index 393 



SEXUAL IMPOTENCE. 



INTRODUCTION, 



No one denies that the sexual function is of very 
great consequence to the individual as well as to 
society in general, although most people do not 
care to make this a subject of conversation. 

"At any rate, the sexual function forms the most 
powerful factor in individual and in social life. It 
is a mighty impulse for bringing into action our 
most effective energies, for acquiring property, for 
the foundation of a home, for rousing altruistic feel- 
ings for a person of the other sex first, and, later, for 
one's children, and, in a wider sense, for the whole 
human family." 1 The Massachusetts statute con- 
cerning divorce says: "A divorce from the bond of 
matrimony may be decreed for — among other causes 
— impotency of either party." The English and 
German law is to the same purport: "Any incur- 
able cause of complete inability to perform the mat- 
rimonial duty, any incurable bodily infirmity which 
excites loathing .and disgust or wholly prevents 
the attainment of the objects of matrimony." 2 
The civil code of Austria correctly estimates the 

1 Krafft-Ebing, Psychopathia sexualis. Stuttgart, 1886, p. 2. 

2 Draper, A Text-book of Legal Medicine. Saunders, Phila. 
and London > 1905, p. 96. 

2 17 



1 8 SEXUAL IMPOTENCE 

importance of sexual virility, Article 60 declaring 
that "the continued inability to fulfil the conjugal 
duty is a bar to marriage." The criminal code 
(Section 156) declares, "But if the crime has caused 
the loss of the procreative power of the injured man, 
then the punishment of imprisonment with hard 
labor is to be meted out for from five to ten years." 

Without virility there can be no procreation. That 
the semen of impotent men frequently contains sper- 
matozoa need not be taken into account in consider- 
ing the propagation of the race, and, generally speak- 
ing, there are certainly but very few persons who owe 
their lives to impotent fathers. 

He who has become prematurely impotent is one 
of the most unfortunate creatures, his misfortune 
being the greater as he mostly is ashamed of it, 
thinks he must conceal it, is pitied by no one, but 
scorned, and, alas, not always can he hope for 
recovery. I venture to assert that in many cases 
it is a better deed to restore to an impotent man 
the power, so precious to every individual, than to 
preserve a dangerously sick person from death, for 
in many cases death is preferable to impotence. 

The energy of man, his courage,- his enjoyment of 
work and life, all, with hardly any exception, depend 
on his sexual power. Purposely we disregard here 
the sundry vows of chastity made by persons who 
expect to be rewarded in the hereafter for their 
voluntary martyrdom here below. These people 
hardly seem to be enjoying their lives, and they call 
this world a vale of tears. Now, this world is not 
exactly a vale of tears or of grief ; but let a man who 



INTRODUCTION 1 9 

has to labor and produce from early morning till 
evening, who must day after day begin ever anew 
the struggle for existence, lose that little bit of love 
and his pathway will lead through a vale of tears 
indeed. The difference between the view of things 
in general formed by old people and that formed by 
the young has its only explanation in the virility ex- 
tinguished in the former and vigorous in the latter. 
Prematurely impotent people very often appear 
aged physically, and always mentally. Moreover, 
we must not forget that the sexual nervous system 
is closely related to all the rest of the nervous mech- 
anism, including those parts essential to its physio- 
logical operations. "The feeling of sexual impo- 
tence is the most humiliating which can ever afflict 
a man; because it degrades him in his own eyes, and 
does not leave a single possible illusion, not a solitary 
moment of mercy." 1 Eunuchs and the sexually 
impotent differ in appearance and in conduct from 
their fellow-men who are in full possession of virile 
power. Even though executed with talent and 
spirit, the work of an impotent man bears the stamp 
of impotence. 

In the year 1878 I happened to be in the Paris 
Salon with one of the most famous French painters. 
While contemplating some paintings, the great mas- 
ter, to whose words a crowd of artists were eagerly 
listening, said, "That painter must be impotent.'* 
To a question of mine the master replied that he was 
able to tell by a picture, not only whether it was 
painted by a young man or an old one, but also the 

1 Lallemand, Pertes seminales, tome ii., i re partie, p. 132. 



20 SEXUAL IMPOTENCE 

condition of the artist's sexual power. To-day I 
give full credit to this assertion, as I am convinced 
that with some experience one can distinguish an 
impotent man from a virile one merely by his looks, 
demeanor, ideas, words, and works. 

The exterior of an impotent man, whether his 
impotence be real or imaginary, does not always 
suggest physical weakness; on the contrary, many 
present a very healthy appearance, and are stout. 
The keen-eyed public have baptized this corpu- 
lency "capon-obesity." In spite of the apparent 
healthiness, the impotent man is generally melan- 
choly, discontented, and peevish. The prematurely 
impotent are, without exception, ill-humored, pessi- 
mistic and can be cheered up even for a short time 
only with great difficulty. Most of them are grudg- 
ing, cowardly, envious, and wicked. They are all 
very jealous, as may easily be understood. The 
younger they are, the handsomer their bodies, the 
higher their social rank, the more pronounced is 
their bad character. 

The character of a man must, as a matter of 
course, be considerably affected by the consciousness 
of impotence. No one is more severe than the 
impotent in passing judgment on his neighbor. No 
one so ruthlessly or mercilessly condemns a misdeed, 
caused by passion, against the very wise prescripts 
of Ethics. Since he cannot join the virile in their 
enjoyments of life, he makes a merit of his incapacity. 

The striving of a man to found for himself a home, 
a family, is a stimulus to work and to the accomplish- 
ment of great deeds in his sphere of life. Such a 



INTRODUCTION 21 

stimulus does not stir the impotent. Although they 
do not care for life, yet they are cowards. It is very 
seldom that an impotent man turns dare-devil and 
shows a contempt for death, due to despair. Some 
puzzling suicide cases of newly married men can 
thus be explained. 

The impotent are incapable of love ; for, as Krafft- 
Ebing says, " With all the morality which love needs 
to rise to its true and pure character, its most vigor- 
ous root is nevertheless sexual passion. Platonic 
love is a nonentity, a self-deception, a wrong desig- 
nation for cognate feelings." 1 Similarly, ambition 
is closely dependent upon the sexual power, as it 
seldom makes its appearance before puberty. 

Finally, it must not be forgotten how wretched a 
part is played in matrimony and in every other rela- 
tion to a woman by the man who is completely or 
even partially impotent. He must renounce the af- 
fection and regard of a woman. Galopin 2 is quite 
right in saying, ''Without this good friend (the 
woman) the dawn and evening of life would be help- 
less, and its mid-day without pleasure." With all 
the capacity for self-sacrifice which is inborn with 
the entire sex, women will nevertheless seldom soar 
to so high a degree of self-abnegation as to love an 
impotent man. It is the aim of every husband to 
hold a dominant position in his family; the more so 
as the weight of his voice is less elsewhere. My ob- 
ject is not to examine whether such a position is in 
the interest of the man himself and of his family, but 

1 Krafft-Ebing, Psychopathia sexualis. Stuttgart, 1886, p. 9. 

2 Le parfum de la femme. Paris, 1886, p. 101. 



22 SEXUAL IMPOTENCE 

I wish merely to call attention to the fact that the 
influence of an impotent man must be very insig- 
nificant with a woman living with him, whether 
she be wife or mistress. 

I further wish to point out that many fallen women 
would have continued good and faithful had their 
husbands not been more or less impotent. The 
greater share of sexual appetite roused inconsider- 
ately or ignorant ly remains unsatisfied, and much 
matrimonial happiness is ruined by the husband's 
impotence. "Tutavia la compagnia fra moglie e 
marito si conferma grandemente per questo atto, e 
non puo far miglior cosa il marito per tenersi affet- 
tionata e pacificata la moglie, che questa e spesso. 
Perche a questa foggia, tutta la casa sta in pace, e 
tranquilla, e tutte le cose vanno bene." (Levinio 
Lennio.) 1 

Now and then as mentioned before impotence 
leads to suicide. Marc 2 tells, for instance, of a 
young man who, before committing suicide, had 
written down the words, "I am impotent, conse- 
quently I am good for nothing in this life." 

If impotence declares itself slowly and gradually, 
refuge is not so often taken in this safe though ex- 
treme remedy for all diseases; but is applied more 
frequently when the calamity shows itself at once 
and without a state of transition, so that the patient 
understands plainly that there is no help for his ail- 
ment, and' thus has no time to accustom himself 
to his misfortune. Richer and 3 made the observa- 

1 Mantegazza, Igiene dell'amore. Milano, 1881, p. 95. 

2 Mantegazza, op. cit., p. 143. 

8 Roubaud, Traite de l'impuissance. Paris, 1876, p. 66. 



INTRODUCTION 23 

tion that after penis amputation the patients be- 
come melancholy, and consequently are more 
subject to malignant wound fever (?), which often 
causes death, while other mutilations by surgical 
operations are borne with fortitude. Lallemand 1 
tells of a man forty-five years old who, after penis 
amputation, when on the point of leaving the 
hospital, received a visit from his wife, after which 
he grew gloomy, mournful, taciturn, and died sud- 
denly. The most careful autopsy failed to reveal 
any cause of death; Lallemand ascribes the fatal 
result to despair. In this case the patient had so 
much the more reason for despair, as the sexual 
appetite had not vanished with the loss of the 
penis. The Russian Skopzi after having been 
maimed suffer a complete change of character: 
they grow egotistic, malicious, hypocritical, and 
covetous. 2 It is to be observed, however, that sur- 
gical operations performed on the genitals can cause 
genital reflex neuroses in the form of melancholia. 3 

Even very old people are not exempt in this re- 
spect. In February, 1900, I amputated the penis of 
a man seventy-three years old. Two days after the 
operation he grew violent and almost unmanageable, 
though the temperature remained normal at all 
times. The formerly jovial gentleman became dis- 
mal, irritable, and taciturn. He remained in 

1 Op. cit., p. 38. 

* Mantegazza, Gli amori degli nomini. Milano, 1886, p. 182. 

3 Kurz, Zwei innere Urethrotomien, gefolgt von Melancho- 
lie. Ref. der med.-chir. Rundschau. Wien, 1887, Heft xviii, 
p. 683. 



24 SEXUAL IMPOTENCE 

good health for several years after the mutilation, 
but was always ill-humored. 

The fate of being impotent is borne with more 
stoicism when along with the loss of virility goes 
that of every desire for intercourse with the other 
sex. Here again we find in Lallemand 1 a typical 
example: A man about thirty years of age, who, in 
consequence of an injury of the occiput, was left 
without sexual appetite, and whose testicles were 
atrophied, used to talk in a joking way and quite 
merrily about his injury and its sad consequences. 
No doubt the personal character is of great impor- 
tance here, as each individual shows different charac- 
teristics in the reaction following injury. 

The impotent are misanthropic and distrustful. 
They are ever afraid that the defect of which they 
feel ashamed may be discovered. All this is aggra- 
vated by self-reproaches of the worst kind, for almost 
every one believes he has himself caused his misfor- 
tune. A reason for self-reproach is soon found, for 
who has not indulged in real or imaginary sexual 
excesses or self-abuse? 

These people are so much ashamed of their defi- 
ciency that they will not acknowledge it, even to 
the physician, except in a most reluctant manner. 
It is, therefore, advisable to meet the communica- 
tions of an impotent person with the required scep- 
ticism from the very beginning. This sense of 
shame is more intense with people of humble condi- 
tion than with those of a higher social rank, who will 
not infrequently speak of their impotence in a 

1 Op. cit., p. 41. 



INTRODUCTION 2$ 

joking tone, even where it might not be expected, in 
order thus to make you believe the contrary. I had 
an opportunity to observe a case where a member 
of the nobility was by every one considered to be 
impotent. Under the cover of this reputation the 
nobleman was following up several intrigues, until 
at last it was discovered that his inability was not 
to be relied upon. 

So far we have had under consideration the influ- 
ence of impotence upon the mind, and have seen that 
it is of no slight degree. The influence of this dis- 
ease upon the body is no less important. We shall 
at present neither consider circumstances which are 
the cause, but not the consequence, of impotence, 
nor circumstances which may be the consequence 
of spermatorrhea. 

The cessation of so important a process as the 
sexual function cannot occur without producing 
by itself an essential change in the individual. 
According to Arndt, 1 there is no disturbance of any 
function of a man without change in the man him- 
self. Real impotence has a powerful influence, 
primarily over the mind, and secondarily over the 
state of health of the entire body. It is conceivable 
that a person who is dull or mournful and always ill- 
humored, who is plagued by a bad thought, must by 
degrees lose his appetite, suffer from indigestion, 
and consequently must become physically ruined; 
though, no doubt, one often meets, as previously 
said, impotent persons looking thoroughly well and 
healthy. 

1 Die Neurasthenie. Wien und Leipzig, 1885, p. 3. 



26 SEXUAL IMPOTENCE 

Howell 1 voices a popular sentiment when he says : 
"The reproductive organs might be eliminated en- 
tirely and the power of the body as an organism to 
maintain its individual existence not be seriously 
interfered with." No doubt this is true when we 
consider that the oyster also has an "individual 
existence." 

Impotence besides being a very serious disease is 
also of frequent occurrence. " Experience proves 
that the large towns especially harbor crowds of per- 
sons suffering from a diseased nervous system, who, 
in the different stages of life, are afflicted with sexual 
infirmities which throw a gloom over their existence. 
Youths who have scarcely stepped beyond the 
threshold of puberty, adults who are at the entrance 
or perhaps at the zenith of manhood, no less than 
individuals who have already reached the autumn of 
their lives, make up elements of these numerous 
groups of the sexually discontented who are suffer- 
ing from diseases of the nervous system, as burden- 
some as they are unyielding. Victims of an unequal 
fate, some more, some less severely wounded in 
the combat against untoward circumstances — un- 
equally furnished with chances for improvement — ' 
all these pitiable persons are nevertheless ani- 
mated with the same desire, that of being once 
more admitted to the full enjoyment of life and 
being able to found a family." 2 "It is quite 

1 A Text-book of Physiology, Saunders, Philadelphia and London, 

1913, P- 944. 

2 Rosenthal, Ueber den Einfluss von Nervenkrankheiten auf 
Zeugung und Sterilitat. Wiener Klinik, 1880, p. 136. 



INTRODUCTION 27 

incomprehensible that there should be physi- 
cians who almost absolutely deny the existence of 
impotence." 1 

Every being instinctively longs for enjoyment. 
The desire for enjoyment is certainly justified, and 
only hypocrites or people with limited views of 
things in general can demand that man shall work 
and fulfil duties without the moments of gladness 
and gratification that are so scarce in comparison to 
the bitterness of life. "La nature veut que nous 
jouissions." 2 

Sensual love and the so-called ideal love, which 
grows out of it, but which is quite an impossibility 
where there is no sexual vigor, are foremost among 
the few joys and gratifications. 

Those who are seeking help for their impotence 
are surely very pitiable subjects ; they feel themselves 
unutterably unhappy, and, in most cases, entertain 
thoughts of suicide, though they seldom have the 
necessary courage to carry them out. A good man 
cannot refuse his assistance to them. It cannot be 
the physician's task to question whether one or an- 
other of them owes his infirmity to his own or some- 
body else's fault. Nor can it be expected from the 
medical man that he should investigate what may be 
the object or aim of any patient who is endeavoring 
to recover his virility. The physician has to keep 
in view only one object, that he is in the presence of 
an unfortunate person whom he must help if he can. 

So much for the determining of my standpoint 

1 Lionel S. Beale, Our Morality. London, 1887, p. 34. 

2 Renan, L'abbesse de Jouarre. Paris, 1886, p. 29. 



28 SEXUAL IMPOTENCE 

and to justify the total separation of impotence and 
sterility. 

And now the question suggests itself, What is im- 
potence? It is well-nigh impossible to give a precise 
answer. The authors seem not to be satisfied with 
the simple explanation, that it is loss or lack of 
power to copulate. Maximilian v. Zeissl, for in- 
stance, gives the following definition: "Impotency 
is a collective idea of the various pathological details 
which hinder a man in the carrying out of coitus, so that 
the ultimate purpose, viz., that of begetting a child, 
is not attained in spite of sexual intercourse with a 
fertile woman." 1 This definition is far-reaching, 
because, though we may include both the impotentia 
cceundi and the impotentia generandi, it should yet 
be said that, in spite of sexual intercourse with a 
fertile woman, the begetting of a child "must" 
remain unattained. 

It is much easier to give a definition of sexual vir- 
ility. Sexual virility is that condition of the body, 
of the nerves connected with the generative organs, 
of the centers of these nerves, and of the genital or- 
gans themselves, which enables an individual to ac- 
complish the sexual act with an acceptable woman 
always, under all circumstances, and within the 
limits set by nature. 

This ideal condition of virility is somewhat rare 
with men following the customary manner of life of 
our days, and in any given case it will generally last 
for but a short time. Every deviation from this 

1 Dr. M. v. Zeissl, Ueber die Impotenz des Mannes und ihre 
Behandlung. Wiener med. Blatter, 1885, Nr. 15. 



INTRODUCTION 29 

ideal condition must, indeed, be reckoned as a start- 
ing-point of impotence. The lesser deviations are 
not taken into account, and are generally considered 
as in the nature of things. 

When virility is in full vigor the sight, the slight- 
est touch, the first embrace of the desired woman 
must cause sexual desire and the erection necessary 
to the performance of the act. The individual is in 
the same degree approaching impotence when he re- 
quires longer preparations and longer and more in- 
tense excitation to produce the necessary sexual 
rousing. Of course, we do not consider here the re- 
petition of coitus after short intervals. The reverse 
of the aforementioned ideal condition is that state 
which we call total impotence, in which condition 
the individual can never have an erection or experi- 
ence excitement, and can, therefore, never, under 
any circumstances, perform the act of coition. As 
nature never progresses by leaps and bounds, so 
these two forms of sexual capacity do not pass ab- 
ruptly from one into the other, but between them 
are numberless transitory forms of impotence. 

Although this essay is written for medical men 
only, who are conversant with the anatomy of the 
genitals and with the physiology of procreation, we 
shall devote a few pages to both Anatomy and Physi- 
ology. In the course of years and the throng of pro- 
fessional occupations small matters escape the mem- 
ory of the practitioner, and occasionally we may 
read again, with profit, that with which we are 
supposed to be well acquainted. 



CHAPTER I. 
ANATOMY. 

We shall now give a rough sketch of the male or- 
gans of reproduction. For more minute study we 
refer the reader to the great number of excellent ana- 
tomical works. 

The male genitalia have been divided into different 
sections; but as this separation contributes in noth- 
ing to the clearness of the subject, we shall simply 
discuss the different organs in their turn. 

The testicles (testes, testiculi, orchides, didymi) 
are a pair of oviform, glandular organs. We shall 
first consider the coverings which protect and sup- 
port them. Proceeding from the outside inward, 
we find first the outer skin starting from the peri- 
neum, from the inner surface of the upper thighs, 
from the root of the penis, and from the pubis, and 
forming the scrotum or purse. The whole of the 
scrotum appears asymmetrical, hanging a little 
lower on the left side. The slight enlargement of 
the cutis forming the median raphe, which runs from 
the perineum forward to the inner surface of the pre- 
puce is not exactly in the median line, but draws 
somewhat to the left. This raphe separates exter- 
nally the whole genital apparatus into two halves, 
thus indicating the inner division. 

At the scrotum we find the epidermis, cutis, and 

3° 



ANATOMY 31 

tunica dartos. The epidermis is distinguished by the 
amount of pigment it contains ; the cutis, by a strong 
growth of hair, sudoriparous glands, and. a rich rete 
of lymphatics. The tunica dartos is a fibrous, fleshy 
membrane, consisting of rather strong, smooth, mus- 
cular fibers, elastic, without fat, and ligamentous in 
character. Still proceeding inward, we next come to 
the tunica vaginalis communis, which envelops the 
testicle and spermatic cord. That part which sur- 
rounds the spermatic cord is loose and spongy, con- 
taining here and there adipose tissue, and is inti- 
mately connected with the spermatic cord and the 
scrotum. This portion of the tunica vaginalis com- 
munis consists of three layers — an inner, an outer, 
and a median muscular layer. These layers or 
membranes are not in all parts distinctly separated 
from one another, because the musculus cremaster 
which separates them runs in isolated flat bundles 
down the spermatic cord; between the bundles the 
two layers run into each other. These isolated flat 
fasciae of the cremaster pass in a fan-like manner 
downward, twining around the testicle. These mus- 
cular bundles have the power to draw the testicle 
upward and outward. Contraction of this muscle 
ensues reflexly from violent movements of the 
abdomen; also as the result of independent action. 
The testicle may, besides, be raised through the con- 
traction of the muscular fibers in the tunica dartos. 
Immediately enveloping the testicle we find the 
'tunica vaginalis propria, which may be divided into 
two layers — namely, the parietal membrane, which 
is connected with the tunica vaginalis communis, and 



32 SEXUAL IMPOTENCE 

the visceral membrane, which is united with the al- 
buginea of the testicle and the epididymis. 

As the testicles produce the sperm, they are the 
most important part of the male generative organs. 
The testicles lie side by side in the scrotum, hanging 
down between the thighs, below the symphysis pubis, 
each in its own compartment, and separated from its 
fellow by a median membranous partition — the sep- 
tum scroti. The testicles are in the abdominal cavity 
until the seventh month of fetal life, when they de- 
scend through the inguinal canal into the scrotum. 

The left testicle is slightly larger than the right 
one and hangs a little lower, this arrangement being 
very appropriate, as it prevents friction of the 
testicles in case of the sudden pressing together of 
the thighs. 

In the testicle we have, first of all, to distinguish 
between the testicle proper (Henle calls it testicular 
gland, others call it main or chief testicle) and the 
epididymis. 

The testicles are oviform in shape, flattened later- 
ally, with the greatest diameter four to six centi- 
meters in length, directed obliquely from above down- 
ward, forward, and outward. The weight of the 
testicle is fifteen to 24.5 grams, its cubic contents 
twelve to twenty-seven cubic centimeters, its length 
five centimeters, its breadth 2.5 centimeters, its 
thickness three centimeters. Weight and volume, 
length and breadth, are subject to great variations 
in different individuals, and fluctuate considerably 
even in the same individual. In spite of Henle' s 1 

1 Handbuch der Anatomie. Braunschweig, 1874, p. 366. 



ANATOMY 33 

opinion to the contrary, my experience teaches me 
that this fluctuation in the volume of the testicle 
corresponds to the amount of seminal fluid contained. 
It is true that the testicle does not collapse immedi- 
ately after coition, but observation has convinced 
me that the volume increases after unusual absti- 
nence; so that I feel sure that contraction of the 
scrotum is here not the main cause of variation. 

Having noted that the testicle is an oviform body 
flattened laterally, we observe further two points, 
the upper and the lower, and two margins (anterior 
and posterior) connecting them; also two flat sur- 
faces, an inner and an outer. The superior point 
and the posterior margin are covered by the epidid- 
ymis and the beginning of the seminal cord. 

Directly investing the testicular gland itself is 
the tunica albuginea. This is a dense, fibrous mem- 
brane, brilliantly white, 0.6 millimeter thick, con- 
taining numerous ramifications of veins and small 
arteries, and becoming considerably thicker and 
more vascular toward the posterior margin. From 
its inner surface it sends off numerous bundles of con- 
nective tissue, and, at almost regular intervals, 
stronger flat transverse bundles, dividing the tissue 
of the testicle into numerous conical lobules, the 
number of which is placed by different authors at 
from one hundred to three hundred. Each lobule 
contains a great number of very fine tubules, called 
spermatic canals, or vasa seminalia. These have a 
volume varying, according to the degree of disten- 
tion, from 0.1 to 0.2 millimeter. They inosculate 
with one another, and are very tortuous, so that it is 
3 



34 SEXUAL IMPOTENCE 

difficult to disentangle them. Their number is esti- 
mated at eleven hundred. 

As we have stated, the tunica albuginea becomes 
much thicker toward the posterior margin, this en- 
largement forming what is called the corpus High- 
mori. Here the seminal tubes collect, three to six 
inosculating, and grow less and less tortuous until 
they become almost straight and form the rete vas- 
culosum (seu Halleri) testis. From this rete start 
about twenty larger tubes running almost in a 
straight line, and passing through the tunica albu- 
ginea into the epididymis; there they form lobuli 
again, giving rise to that single tube with manifold 
convolutions which constitutes, in the main, the par- 
enchyma of the epididymis. 

Besides the seminiferous tubules, the parenchyma 
of the testicle contains comparatively large winding 
vessels with thick walls and a cellular mass, of the 
function of which we still know nothing positive, and 
which many anatomists and physiologists consider 
to be connective tissue. Before entering the epidid- 
ymis the seminiferous tubules change in structure 
and become simply excretory ducts. 

The epididymis properly considered is merely an 
excretory duct of the testicle. It is a body weighing 
generally 1.5 grams, its cubic contents being 1.78 
cubic centimeters. Its upper end is globular in form 
and tapers off to pass into the vas (recte ductus) 
deferens. The epididymis is also invested with a 
tough albuginea, which has the same structure as 
the albuginea of the testicle, but is not so thick, its 
thickness being only 0.04 millimeter. The inner 



ANATOMY 35 

surface of the albuginea of the epididymis also sends 
off septa of connective tissue into the parenchyma, 
dividing it into lobules, though superficially only. 

The unfolded vas (recte ductus) epididymis has a 
length of about six meters, with a diameter of 
about 0.44 millimeter, and gradually dilates as it 
approaches the vas deferens. Besides this principal 
duct, the epididymis contains also one to three 
small blind canals, the vasa aberrantia and the so- 
called hydatis Morgagni, which are said to be rem- 
nants of embryonic conditions. 

At the lower point of the testicle the canal of the 
epididymis is turned directly upward in order to 
reach the orificium cutaneum canalis inguinalis; it 
is then called the vas deferens, and, together with the 
vessels and nerves running in the same direction, 
forms the seminal cord (plexus spermaticus seu 
pampinif ormis) . The so-called vas deferens is no 
vas, but a duct ; we shall drop the misleading name 
and term it ductus deferens. 

The tortuosity of the epididymis continues into 
the first part of the ductus deferens, but the tube 
becomes gradually more nearly straight, its walls at 
the same time increasing in thickness and extent. 
The total length of the seminal duct is about fifty 
to sixty centimeters. According to Henle, 1 the 
straight part is about three millimeters in diameter, 
one-sixth of which is taken up by the lumen, so that 
the thickness of the wall is 1 . 5 millimeters. On this 
thickness depend the firmness and cylindrical form 
of the ductus deferens. 

1 Op. cit., p. 382. 



36 SEXUAL IMPOTENCE 

Before the seminal duct unites with the seminal 
vesicle it forms the spindle-like ampulla of Henle. 
The lumen in this place becomes almost doubled in 
extent, the thickness of the wall increasing also. 
The mucous membrane is folded, and resembles a 
great deal that of the seminal vesicles. 

The ampulla is a very important part of the 
sexual organs, but has so far never received proper 
consideration. At the end of the ampulla the vas 
deferens grows thinner again, and has outlet in the 
inferior pointed end of the seminal vesicle lying at 
the outer part of the base of the urinary bladder, 
between the bladder and rectum. The end of the 
ductus deferens forms with this pointed end of the 
seminal vesicle the ductus ejaculatorius. 

The seminal vesicles are really hollow glands of a 
very irregular form, resembling a very knotty, some- 
what flattened club. Even in the same subject the 
two vesiculae seminales differ in form and size. The 
length of the vesiculae seminales varies from four 
to 8.5 centimeters, their diameter from 0.6 to 0.7 
centimeter. The superior end is blunt, usually hav- 
ing a hump-like protuberance, which, looked at from 
the outside, resembles a small hunch. The entire 
surface looks uneven or rough, the little hunch-like 
prominences corresponding to depressions on the 
inside. 

The interior of the seminal vesicles is still more 
peculiar, and varies just like the exterior. The mu- 
cous membrane is of a yellowish tint, infolded, has 
little pits, and forms depressions and longer or shorter 
diverticular. The organ has altogether a cellular 



ANATOMY 37 

appearance. In the mucous membrane there are 
some peculiar glands, which, though the granular 
epithelium is different, have a structure similar to 
that of the mucous glands, but produce a secretion 
essentially different from mucus, as it does not 
congeal in acetic acid. 1 

By the union of the deferential ducts with the vesi- 
cular seminales the ejaculatory ducts are formed about 
the superior margin of the prostate gland, but with 
numberless variations in the share provided by the 
individual organs in this formation. 

The parietes of the ductus ejaculatorius are about 
0.4 millimeter thick, the lumen one millimeter in 
diameter. While the lumen runs from two to three 
centimeters forward and downward through the 
prostate, it diminishes in volume; the mucous mem- 
brane, which at first resembles that of the vesicula 
seminalis, losing gradually its folds and its glands, as 
well as its yellowish tint. The two ejaculatory 
canals also frequently exhibit variations with respect 
to form, course, convergence, and mutual contact. 
Even coalescence of the two ducts into one may take 
place. The ejaculatory canals lead into the pros- 
tatic part of the urethra near the verumontanum 
or colliculus seminalis, opening by circular mouths. 
The fact, minutely described by Henle, 2 that the 
muscular membrane of the ductus ejaculatorius 
within the prostate assumes the character of a cav- 
ernous tissue seems to me of special importance. 

1 Compare Barnett's very interesting anatomico-surgical 
study: The vesiculse seminales. Transactions of A. Urol. 
Ass., 1909, pp. 65-68. 

2 Op. cit., p. 388. 



38 SEXUAL IMPOTENCE 

The prostate, shaped like a chestnut or flattened 
cone, embraces with its anterior surface the neck of 
the bladder and the first portion of the urethra, its 
posterior surface resting on the anterior wall of the 
rectum. This posterior part of the gland is divided 
into two lobes by the ejaculatory duct. The texture 
of the prostate is firm, the borders rounded off. 
The superior border or margin which surrounds 
the bladder is broader, slightly bent in the middle, 
while the inferior margin tapers off. The greatest 
diameter of the prostata measures thirty-two to 
forty-five millimeters; from the base to the point it 
is twenty-five to thirty-five millimeters; its thick- 
ness, fourteen to twenty-two millimeters. Its 
weight is estimated at seventeen to 18.5 grams. 

According to Henle, the prostate comprises three 
different organs, or, rather, structures — a number of 
racemose glands, the glandula prostatica; a closing 
muscle of the bladder, composed of smooth muscular 
tissue, the sphincter vesicas internus; and a trans- 
versely striped closing muscle of the bladder, the 
sphincter vesicas externus. Besides these, we have 
to notice in the wall of the ductus ejaculatorii, of the 
sinus prostaticus, of the urethra, and of the collicu- 
lus seminalis, the peculiar structure which sends off 
shoots into the substance of the prostata and also the 
exterior coat of the glandular portion, together with 
the separating walls or septa starting from it. 
Walker, 1 however, claims that the whole muscular 

1 George Walker, A contribution to the study of the anat- 
omy and physiology of the prostate gland . . . , Johns Hop- 
kins Hospital Bull., Oct., 1900. 



ANATOMY 39 

structure of the organ is arranged primarily to 
compress the prostate, and not to act as a vesical 
sphincter. 

Some superficial authors seem to think that 
the anatomy of the sexual organs is a closed 
chapter and should only be treated in text-books. 
Kolischer 1 evidently is not of the same opinion 
and emphasizes that Zuckerkandl and Tandler 
have called attention to the fact that our usual 
terms describing the prostatic anatomy and the 
pathology of prostatic hypertrophy are in need 
of a thorough revision. Our accepted division of 
the prostate in two lateral and one median lobe 
does not correspond with the anatomic facts, and 
that what we call "the surgical capsule" of the 
prostate is a misnomer. Zuckerkandl and Tandler 
agree with Freudenberg's statement that the pros- 
tatic capsule of the surgeons consists of compressed 
prostatic tissue. 

It is now generally conceded that the physiological 
function of the prostate is almost exclusively a genital 
one. The prostatic fluid mixes with the spermat- 
ozoa, the product of the seminal ducts and the 
seminal vesicles to make up the fluid which we call 
semen. The muscular part of the prostatic gland 
causes the action of the ejaculatory ducts and prob- 
ably prevents the ejaculated semen from flowing 
into the bladder. Herrick 2 says that the former idea, 
the prostate greatly aiding in the control of the 

1 A prostatic study, Jour. Amer. Med. Assoc, July, 6, 19 12, p. 8. 

2 Prostatic hypertrophy and its radical cure. Med. Record, 
Aug. 15, 1903, p. 243. 



40 SEXUAL IMPOTENCE 

bladder is given up, as in eunuchs with atrophied 
prostates, or in children in whom they are not 
developed, and in women in whom they are absent, 
urinary control is not interfered with, and in many 
cases of complete prostatectomy incontinence is the 
rare exception. 

The main substance of the prostata is the real 
gland, which does not reach complete development 
until after puberty, as the glandular ducts and vesi- 
cular develop greatly at the expense of the substance 
of the connective tissue, which predominates before 
puberty. They give to the whole gland a yellowish- 
red tint and a spongy appearance. 

The relative proportion of the muscular fibers and 
the glandular substance in the prostate varies con- 
siderably in different individuals. Morris 1 consid- 
ers the muscular element, comprising both striped 
and unstriped fibers, to represent about one-half of 
the entire mass. In one subject the glandular spaces 
may be predominant, and in another their contracti- 
ble coatings, so that in one person the secreting func- 
tion of the prostate may predominate, and with an- 
other the motory. 2 Unfortunately, we have, as yet, 
no observations to determine what influence this 
difference in the structure of the prostata has on the 
sexual life. 

The excretory ducts within the prostata unite into 
an indefinite number of stems, which open into the 
urethra at the colliculus seminalis anterior to the 

1 Human Anatomy. Philadelphia, 1899, p. 1022. 

2 Ruedinger, Zur anatomie der Prostata, des Uterus masculinus 
und der Ductus ejaculatorii. Muenchen, 1883, p. 4. 



ANATOMY 41 

mouths of the ductus ejaculatorii. Two of the larg- 
est stems open almost symmetrically, side by side, 
quite close to the openings of the ductus ejaculatorii ; 
the others, from seven to fifteen in number, open 
rather more in front, asymmetrically and with 
variations. 

The secretion of the prostata is of the nature of 
mucus, but is only slightly congealed by acetic acid. 
It is rather significant that even the chemical re- 
action of the prostata' s secretion is not an undis- 
puted item. While Furbringer and Finger claim 
that the motility of the spermatozoa is impaired by 
an alkaline catarrhalic secretion of the prostata 
Schultz 1 found the secretion of the prostata in men 
of normal sexual conditions to be of alkaline reaction. 

We now pass to a short description of the real or- 
gan of copulation, the penis, which, with its corpora 
cavernosa, is perforated by the urethra. 

The urethra, which runs from the neck of the blad- 
der to the exterior orifice of the penis, is divided into 
three portions — the pars prostatica, pars membran- 
acea, and pars cavernosa. The course of the ure- 
thra resembles the letter S — i.e., it has two bends 
or curves, of which the posterior retains its shape 
even during erection. The length of the urethra 
varies very much, and is from fourteen to twenty 
two centimeters, the pars prostatica = 2 to 2.8 
centimeters, the pars membranacea = i.5o to 2.50 
centimeters, and the pars cavernosa = 10.5 to 16.7 
centimeters. There is a similar variation in the 
lumen of the urethra. It is narrowest in the pars 

1 Wien. klin. Wochenschrift, xvii, 43, 1904. 



42 SEXUAL IMPOTENCE 

membranacea, and of varying width, but least exten- 
sible, at the orificium externum. 

In the pars prostatica the lower wall stands out, 
forming the colliculus seminalis (caput gallinaginis, 
verumontanum, crista urethralis) . This is the most 
important part of the urethra, with regard to the 
subject we are treating, as it is the seat of many 
diseases. The caput gallinaginis begins, according 
to Henle, at the urethral mouth of the bladder, with 
two longitudinal folds, converging toward the median 
level space; along with these two there is occasion- 
ally a third, the median fold. The caput gallin- 
aginis may begin with a greater number of smaller 
folds. This crest reaches its greatest extent, in 
height and breadth, at about the middle of the pars 
prostatica, immediately before (under) the sharp 
bend; it then decreases again even less abruptly, its 
transverse diameter diminishing at the same time. 
The anterior end extends, in the form of a narrow 
ridge, far into the pars membranacea, and often 
divides, toward the end, into fork-like branches at an 
acute angle. 

This description is very definite, indeed, but indi- 
cates clearly the great variations we meet in the 
structure of the crista urethralis. These differences 
become still more numerous in consequence of dis- 
ease or the frequent use of instruments. Age also 
has a great influence on the formation of this organ, 
so that variations are met with at every autopsy as 
well as at every endoscopic examination. The same 
thing may be said of the measurements of the breadth 
and height, stated to be about three millimeters. 



ANATOMY 43 

The mucous membrane of the crista gallinaginis is 
laid in small creases, which open out during erection. 

Besides the above-described openings of the duc- 
tus ejaculatorii and of the excretory ducts of the 
prostate, we find at the anterior slope of the collicu- 
lus seminalis a slender follicle without outlet, the 
sinus prostaticus (Morgagni, also utriculus prostati- 
tis or vesicula prostatica). It can scarcely be de- 
termined what function, if any, this structure has. 
At any rate, the statement of Rii dinger, 1 that the 
uterus masculinus has remained capable of contrac- 
tion in a very high degree, in virtue of the smooth 
muscular fibers, which can be demonstrated in all 
parts, may perhaps seem to justify the assumption 
that it performs some functional, possibly a secre- 
tory, part or role. 

The pars membranacea (s. carnosa, s. isthmus) 
urethra is that part of the urethra which, leaving the 
prostata, penetrates into the diaphragma urogenitale 
to enter the corpus cavernosum urethras at the infe- 
rior surface of the diaphragm; from this point on it 
is called the pars cavernosa. 

Next to the posterior border of the diaphragm, 
between the layers of the musculus trans versus peri- 
naei profundus, lie Cowper's glands, belonging to the 
racemose variety. These are two lobulated bodies, 
resembling a mulberry, spherical, sometimes pressed 
flat, and measuring from four to nine millimeters in 
diameter. Their excretory ducts, three to six centi- 
meters long, converge and have their outlets close 
together in the urethra, at the end of the bulbous 

1 Loc. cit. 



44 SEXUAL IMPOTENCE 

and somewhat dilated part of the pars cavernosa. It 
is always difficult and frequently absolutely impos- 
sible to locate these outlets. Even when using Gold- 
schmidt's endoscope they are frequently confused 
with the lacunse Morgagni. At autoptic examina- 
tions it is often necessary to introduce a bristle in 
order to locate the real endings of Cowper's glands. 

The mucous membrane of the cavernous portion of 
the urethra is in longitudinal folds. Besides the 
outlets of Cowper's glands, it contains the very fine 
glands of Littre (o.i millimeter average diameter) 
and the very small lacuna Morgagni, dot-like in ap- 
pearance. The lumen of the urethra is dilated at 
both ends of the cavernous portion, corresponding 
to the bulbous part and the fossa navicularis. 

The entire urethra is lined with cylindrical epithe- 
lium, which in the fossa navicularis, and occasion- 
ally a little before, changes into pavement epithelium. 
Within the region of the pavement epithelium there 
are papillae sometimes 0.22 millimeter in height and 
of diverse forms. Vajda 1 declares that he has dis- 
covered vascular papillae of sundry sizes and shapes 
in the whole mucous membrane of the urethra, 
nearly as far as the pars bulbosa ; and that the pave- 
ment epithelium of the fossa navicularis extends 
over the whole surface of the urethra. 

The wall of the urethra consists of the mucous 
membrane, to which is annexed a layer of areolar 
tissue, the meshes of the latter being stretched in the 
longitudinal direction of the urethra. This areolar 

1 Beitrage zur Anatomie des mannlichen Urogenital-Appa- 
rates. Wien, 1887. 



ANATOMY 45 

layer is, in the prostatic part, the membranous part, 
and the first portion of the cavernous part, enclosed 
by a layer of smooth muscular texture, with which 
many elastic fibers are interwoven. 

The areolar tissue, which constitutes the areolar 
layers of the ductus ejaculatorii, the pars prostatica 
urethrae, and the pars membranacea urethrae, is 
called by Henle compressible areolar tissue, in con- 
trast with the erectile areolar tissue, of which the 
corpora cavernosa urethrae et penis consist. 

The pars cavernosa urethrae is enveloped in a 
cylinder of areolar tissue, which, toward the posterior 
end, gradually thickens to a club-shape and forms 
the so-called bulbus urethrae ; while the anterior part 
suddenly spreads out, covers the anterior ends of the 
corpora cavernosa penis, and thus forms the glans 
penis. Each of the anterior ends runs off into a 
blunt point, which is covered by the anterior expan- 
sion of the corpora cavernosa urethrae. 

The corpora cavernosa penis are a pair of bodies of 
cylindrical shape, slightly flattened on the inside. 
They come in contact in the even median surface, 
while their posterior ends, the so-called roots, diverge 
and fasten themselves on the inner surface of the 
lower border of the inferior branch of the pubis. 
The superior and lateral surfaces of the corpora 
cavernosa can be felt through the outer skin, while 
the inferior surfaces in their contact form the ure- 
thral furrow for the reception of the corpus caverno- 
sum urethrae. 

We must be brief in the description of the corpora 
cavernosa, as details would lead us too far. Each 



46 SEXUAL IMPOTENCE 

corpus cavernosum has a ligamentous, brilliant white 
tegument, consisting of connective tissue and elastic 
fibers, in which there are a few very sinuous blood- 
vessels. This cover, called albuginea of the corpora 
cavernosa, is about two millimeters thick when the 
member is flaccid, but grows much thinner when the 
corpora cavernosa are filling. 

From this albuginea proceed into the interior of 
the corpora cavernosa transverse vascular bundles 
of connective tissue, consisting of elastic filaments 
and smooth muscular fibers, and parietes or septa, 
with small interstices between. Thus is formed the 
spongy texture of the corpora cavernosa. These 
small interspaces are coated with vein epithelium; 
all are interconnected by emissarias. 

Henle asserts that these interspaces are vascular 
plexuses between the ends of arteries and the be- 
ginnings of veins, as neutral in character as the capil- 
lary rete of other tissues. They may be considered 
capillaries which have dilated and run together at 
the cost of the intermediate tissue, partly through 
atrophy of the latter, and which have reduced the 
intermediate tissue to a number of transverse bands 
and leaf-like septa, in which run some supplying 
vessels as well as ordinary capillaries of the usual 
diameter. 

We omit as unnecessary a description of the cutis 
of the prepuce, the frenulum, and, in a word, of 
the exterior of the penis. Every physician is aware 
of the individual differences in the volume of the en- 
tire penis, of the length and form of the prepuce. 

The inner surface of the prepuce is devoid of hair, 



ANATOMY 47 

smooth, and shining. The surface of the glans when 
the member is flaccid is slightly furrowed, and conse- 
quently dull in appearance; during erection it be- 
comes even and shining. There are numerous se- 
baceous glands on the arched surface of the glans, on 
the prepuce, and around the frenulum; moreover, 
there are many papillae differing in number and size. 
Sometimes single papillae are found also on the inner 
surface of the prepuce where it joins the corona. 

Following the lucid description in Morris' Human 
Anatomy, we find that the nerves of the scrotum are 
derived from the genitocrural and superficial peri- 
neal ; the nerves of the testicle from the aortic, renal 
and hypogastric plexuses. The nerves to the vas 
deferens form a slender plexus which accompanies 
that structure as far as the internal abdominal ring, 
where it unites with the spermatic plexus. The 
nerves of the vesicula seminalis and the prostata are 
derived from the hypogastric plexus. "The secre- 
tory nerve of the prostate gland is the descending 
branch of the inferior mesenteric ganglion. The 
vasodilator fibers of the prostate are contained in the 
nervus erigens and its two branches." 1 

The integumentary structures of the penis are sup- 
plied by the genital branch of the genitocrural and 
the superficial perineal branches of the pudic. The 
erectile bodies receive filaments from the dorsal 
nerve of the penis, the superficial perineal, and the 
hypogastric plexus. 

In regard to blood- and lymphatic vessels it is of 

1 Ott, A Text-book of Physiology, 3d ed., Phila., 1909, p. 
858. 



48 SEXUAL IMPOTENCE 

special importance to know that the deferential, sper- 
matic, and scrotal blood-vessels intercommunicate 
freely, as do the testicular and scrotal blood- and 
lymph-vessels behind the epididymis, which ex- 
plains why the ligature or excision of the spermatic 
veins and artery leaves the nutrition of the testicle 
unimpaired; it likewise accounts for the extension 
of inflammatory infections of the epididymis to the 
scrotal integument. 

The prostatic arteries spring forth from the ad- 
joining vesical and hemorrhoidal vessels. The veins 
receive the vena dorsalis penis, then form the plexus 
Santorini, and end in the adjacent vesical veins. 
In view of the frequently attempted ligation and 
excision of the vena dorsalis penis as a cure for some 
forms of impotence, it is important to know, that 
many a would-be operator mistook the vena cutanea 
superficialis for the dorsalis penis, and performed an 
operation just as simple as useless. 

The lymphatic vessels end in the pelvic glands, 
though there is frequently to be found a small gland 
on both sides of the base. 

The envelopes of the penis are supplied by the ex- 
ternal pudic, the superficial perineal, and the dorsal 
artery; the first from the femoral, the others from 
the internal pudic. The corpora cavernosa are sup- 
plied by the cavernous branch of the pudic; the 
corpus spongiosum by the special artery of the bulb 
(internal pudic) and the dorsal artery. 

The veins of the coverings of the penis end in one 
or two superficial dorsal veins which run in the con- 
nective tissue layer between the dartos and fascial 



ANATOMY 49 

sheath, and end in the long saphenous and femoral 
veins. The deep veins of the corpora cavernosa 
and corpus spongiosum terminate partly in the 
plexus of Santorini (chiefly through the deep dorsal 
vein) , and partly in the internal pudic. They com- 
municate freely with each other and with the super- 
ficial veins. 

The lymphatics run with the veins, those of the 
coverings being collected by superficial dorsal trunks 
that pass to the inguinal glands. The deep lymph- 
atics from the corpora cavernosa and corpus spongio- 
sum for the most part join a dorsal cord which runs 
with the deep dorsal vein to end in the inguinal 
glands; a few probably reach the pelvic and lumbar 
glands. 



CHAPTER II. 
PHYSIOLOGY OF THE SEXUAL ACT. 

We shall now consider the male sexual functions, 
with the exception of fecundation, and shall give our 
attention to a short sketch of the physiology of coitus 
alone, without mentioning the processes which cause 
fecundation. Besides, in the following chapters we 
shall pay due attention to the physiology of our sub- 
ject. 

It is generally asserted that, with regard to pro- 
creation, nature has imposed on the woman all the 
burdens, and reserved only pleasure for the man. 
This is so, indeed, if we take into consideration that 
the woman, after conception, has to carry and 
nourish the fruit in her body for nine months and 
then undergo the labor of parturition. So far as 
coitus is concerned, however, in and for itself, the 
greater part devolves upon the man, and, moreover, 
in comparison with the woman, he is at a great dis- 
advantage. I shall not dwell longer on this subject, 
as, strictly considered, it does not enter into the 
framework of our purpose, and I shall make the man 
alone the object of my discussions. 

Sexual Maturity. — In order to perform normal 
coitus the individual must be in possession of all 
the qualities necessary; in the first place, he must 
have attained puberty. In our climate males reach 

50 



PHYSIOLOGY OF THE SEXUAL ACT 5 1 

puberty, on an average, at the age of seventeen. Pu- 
berty announces itself by various exterior signs, the 
most striking being the alteration of the voice, which 
grows deeper and sounds rough and broken during 
the period of sexual development known as the age 
of puberty. This deepening of the voice is caused 
by a certain series of changes in the larynx : the pro- 
cesses vocales become cartilaginous, the larynx 
larger and protruding, the vocal cords lengthened. 
Furthermore, the bones and muscles grow stronger, 
the lungs larger; the pubic region becomes covered 
with hair. But the greatest changes occur in the 
genitals, the testicles enlarging and beginning to 
secrete. The tissue of the penis, capable of en- 
larging, develops disproportionately, and the pre- 
puce loosens from the glans. The sexual impulse 
awakens, and, if not satisfied, results in pollutions. 

This transition of the child into a pubescent man 
requires about two years for its accomplishment. 
Thus, generally speaking, the young man would be 
nubile at the age of seventeen. 

Here I must assert my opinion, in opposition to 
others, Roubaud, for instance, who says that sper- 
matozoa are never found in the semen of youths 
under eighteen years of age. I have repeatedly dis- 
covered perfectly developed spermatozoa in the 
semen of Frenchmen, Italians, Croatians, and Hun- 
garians hardly sixteen years old. I must remark, 
however, that most of these were youths who sought 
for sexual gratification prematurely. 

In 1886, 1 performed the autopsy on a sixteen-and- 
a-half -year-old shepherd, who had been accidentally 



52 SEXUAL IMPOTENCE 

drowned, and whom his comrades had declared to be 
an onanist. I found in the testicles, as well as in the 
excretory ducts, spermatozoa in every grade of devel- 
opment. I also found a great quantity of spermato- 
zoa in the semen of the second pollution of a Croatian 
peasant boy, who was not quite sixteen years old, 
who did not masturbate, and who never had sexual 
intercourse with the opposite sex. 

The individual retains his power to perform the 
sexual functions during a greater or less period of his 
life. There are people who, in their fiftieth year 
become sexually useless in a quite normal manner, 
according to constitution, temperament, and habits. 
On the other hand, it is impossible to state any age 
at which there have not been or may not be men sex- 
ually capable. The procreative power is, however, 
most likely to be extinguished after the age of sixty, 
while the capacity for intercourse is certainly pre- 
served much later. Girault found that the spermat- 
ozoa change after the fifty-fifth year, the heads 
growing larger and the tails shorter; this altera- 
tion certainly not contributing to their power of 
movement. 

Sexual Orgasm. — The copulative power requires 
not only that the individual be virile and his sexual 
instinct unextinguished, but also that he be capable 
of having the necessary libido sexualis and to attain 
the final sexual orgasm, which is a combination of 
centrally or peripherally roused fancies and pleasur- 
able sensations associated therewith. The libido 
sexualis is very frequently in itself a peripheral 
excitement, and in the sexually virile the center of 



PHYSIOLOGY OF THE SEXUAL ACT 53 

erection acts promptly through the afferent and 
efferent nerves. We shall see in our future considera- 
tions that there are many cases where the impotence 
is merely a consequence of complete or incomplete 
absence of sexual excitement. We shall see that 
anything capable of distracting the sexual excitement 
at the given moment, to divert the run of ideas from 
the sexual track, is also capable of causing sexual 
impotence, be it only for the moment. 

What is it, then, speaking generally, that can 
cause the sexual orgasm? If the human male is 
left to himself and nothing comes to disturb the nat- 
ural course, the first sexual rousing will not occur 
until he has reached the state of full sexual maturity ; 
when the testicles, spermatic ducts, and vesiculae 
seminales are filled with sperm. This first sexual 
excitement would occur even in those exceptional 
cases where the individual has no idea of sexual 
things. This is a proof that the accumulation of 
sperm in the seminal organs may and must occasion 
sexual excitement quite independently of the will of 
the individual. On the other hand, we see that 
sexual excitement takes place with persons whose 
seminal organs are anything but full of sperm. It is 
evident that here the sexual excitement comes about 
through mental impressions. The center for mental 
impressions is in the cortex cerebri. Therefore 
sexual excitement may be caused through the me- 
dium of the cortex cerebri, and this is generally the 
case. 

We see individuals whose sexual sense is deadened 
to such a degree that the psychical impressions alone 



54 SEXUAL IMPOTENCE 

can no longer bring about sexual rousing. Such 
people generally have not sperma enough in their 
spermatic organs to cause the rousing, and yet they 
are known to accomplish coition. It is well known 
that these persons are in the habit of putting them- 
selves into a state of sexual excitement by irritating 
the exterior part of the organ, and sometimes have 
recourse to the most loathsome manipulations. 

Indeed, we see that the most diverse irritations, 
practised on the outer and the inner nerves of the 
sexual organs, cause libido sexualis. Thus, for in- 
stance, incidental friction of the genitals by too tight 
garments, an inflammatory or catarrhal condition of 
the urethra, the pressure of a full bladder or of the 
rectum, anal fissures or hemorrhoidal ulcers, irritation 
by worms or by urine containing some medicinal or 
certain alimentary substances, and sometimes even 
the introduction of a sound or a catheter, the mas- 
sage of the prostata may cause hyperemia and second- 
ary libido sexualis. 

Finally, it is known that from the most diverse 
organs sexual erethism can be aroused; above all, 
from the organs of the senses, particularly the organs 
of sight, touch, and smell. It must be observed, 
however, that these cause sexual excitement indi- 
rectly only, by means of the central organ, the cor- 
tex cerebri. The sight of a beautiful woman, the 
touch of certain parts of the body of a woman, the 
agreeable odor of a woman, a lascivious picture, all 
are apt to bring about sexual excitement, but only 
in so far as such impressions on the senses give rise 
to some idea or recollection in the central organ. 



PHYSIOLOGY OF THE SEXUAL ACT 55 

Sexual excitement may arise, therefore, in three 
distinct ways: (i) reflexly and naturally, through 
the accumulation of sperm in the seminal organs, in 
which case there is no intervention of the cortex 
cerebri, the seat of sensation and ideation; (2) psy- 
chically — the most frequent way — through ideas, 
consequently through the activity of the cortex ; and 
(3) unnaturally, by means of direct excitation of the 
sexual organs. 

Here I have no reference to single and rare cases, 
in which it is pretended that the sight of an object in 
no way related to sexual things, odors certainly not 
coming from a woman, the touch of objects not in 
any relation with woman, the eating of certain food 
not physically aphrodisiac, or even impressions on 
the sense of hearing, have produced sexual excite- 
ment. Observations of this nature, if they do not 
belong to the province of fable or are not based upon 
error, can be made only upon individuals psychically 
abnormal, and in most cases can be traced to fancies 
or recollections. 

Thus we see that in sexual matters the cortex cere- 
bri and the sexual organs are in mutually dependent re- 
lations. Ideas and desires which originate in the cor- 
tex cerebri act upon the sexual organs through the 
medium of other centers situated in the lumbar re- 
gion; on the other hand, certain occurrences in the 
sexual organs, principally such as accumulation of 
sperm, create images and ideas of a sexual nature in 
the cortex cerebri, which may seem unaccountable 
to an inexperienced person, but which result in libido 
sexualis. 



56 SEXUAL IMPOTENCE 

Seat of the Sexual Instinct. — It has not yet been 

discovered which part of the cortical substance is 
the seat of the sexual instinct. Ferrier places it in 
the occipito-temporal convolution, near the olfactory 
center. He found that monkeys were capable of 
sexual excitement after the occipital lobe had been 
removed. Arthur SchifFs experiments 1 to verify 
Flies' observations on certain genital regions in the 
nose, are very interesting and decidedly support 
Ferrier 's views. Besides the center of excitement 
there must be a center of inhibition, which, with peo- 
ple who have learned to control themselves, is de- 
veloped in a higher degree, and puts a kind of check 
on the libido sexualis. It is probable that this in- 
hibitory center either does not exist in animals at 
all or is present in a rudimentary form only, and 
is but slightly developed in people on a low mental 
plane. However, this inhibitory center, often very 
beneficent, has also its disadvantageous side. In 
the numerous cases of sexual neurasthenia called 
by various names, the cause often lies in the un- 
timely interference of this inhibitory center. 

The sexual capacity of an individual depends 
mostly on the facility with which he can be brought 
into a state of sexual excitement. Lively and ex- 
citable men, who are easily and on every occasion 
thrown into sexual excitement, are more prone to ex- 
cesses in venery, and, all other conditions being 
equal, accomplish more in this respect than phleg- 
matic, cold natures, with whom it requires a concur- 
rence of several circumstances in order to produce 
sexual erethism. This fact explains also the well- 

1 K. k. Gesellschaft der Aerzte in Wien., Jan. 12, 1901. 



PHYSIOLOGY OF THE SEXUAL ACT 57 

known sensuality of artists, to which years ago 
attention was called in the celebrated Graef case 
at Berlin, and which derived a more conclusive proof 
from the prudish protest of the artists themselves. 

Erection. — Sexual irritation causes the erection of 
the virile member. An erection may, however, take 
place without the excitement by reflex action; but 
such an erection is not sufficient for coitus without 
the addition of sexual erethismus. We apply the 
term erection to that physiological process which 
puts the male sexual member into the condition 
that enables it to make its way into the vagina. 

We shall now direct our attention to what takes 
place in erection. In the chapter on Anatomy we 
have described the structure of the penis, and we 
have seen that, from the tunica albuginea of the three 
erectile bodies, vascular transverse fasciae and septa 
run into the inner part of the corpora cavernosa, 
leaving small interstices, thus converting the corpora 
cavernosa into spongy bodies. These small hollow 
interspaces of the three corpora cavernosa are coated 
with endothelium resembling that of the veins, and 
are consequently venous spaces. Numerous emis- 
saries keep all the corpora cavernosa in communica- 
tion with one another, and open out into the vena 
dorsalis and the vena profunda penis. In the base 
of the penis there are the arteriae helicinae, which are 
wound in the shape of a ram's horn, in order that 
they may yield to the changes of volume in the erec- 
tile tissue. It is now clearly demonstrated that erec- 
tion is caused by a filling of these spaces with blood, 
but the entire process of erection in man is neverthe- 
less far from being explained. The researches on 



58 SEXUAL IMPOTENCE 

this subject by Kolliker, Rouget, Langer, Eckhard, 
Goltz, Loven, and Frey are highly meritorious, it 
must be admitted, but the mechanism of erection has 
still its mystery. 

We know that erection is the result of an increased 
influx of blood into the areolar tissue of the corpora 
cavernosa, together with a decreased outflow of 
blood from the same bodies ; but we are far from un- 
derstanding the cause of that afflux, often quite sud- 
den, and of that checking of the outflow. At first an 
attempt was made to explain the process by the 
macroscopic anatomical relations. It was supposed 
that either the outer transversely striped muscles or 
the inner smooth muscles exercise a pressure on the 
efferent veins. Kolliker's opinion was that the re- 
laxation of the smooth muscles caused erection. 
Opposed to this opinion is the theory that the smooth 
muscles in the walls of the cavernous spaces do not 
possess sufficient strength and energy by themselves 
to influence erection to such a degree ; for when the 
nervus dorsalis penis, which innervates the trans- 
verse fibrous bands of the areolar tissue of the penis, 
has been severed the erectile power is reduced. 
Eckhard has even painlessly irritated the nervus 
dorsalis penis of dogs under chloroform without pro- 
ducing an erection ; nor has an erection ensued after 
the excitation of the central end of the severed nervus 
pudendus communis of a dog. 1 If it were not for 
these experiments, much might be said for the opin- 
ion of Kolliker; for, if these muscles were powerful 

1 Eckhard, Ueber den Verlauf der Nervi erigentes innerhalb 
des Riickenmarks und Gehirns. Beitrage zur Anatomie und 
Physiologie, Band vii, Heft i, p. 70. 



PHYSIOLOGY OF THE SEXUAL ACT 59 

enough, their contraction would certainly prevent an 
erection. On the other hand, the fact that warmth 
causes a dilatation and cold a contraction of the cor- 
pora cavernosa speaks with some force for the influ- 
ence of the smooth muscles. However, this is not 
sufficient for an explanation of erection, and conse- 
quently other theories regarding the physiological 
process of erection have always been sought. Thus, 
Eckhard obtained, through his experiments upon 
animals, the following results: Erection can be 
caused in rabbits by faradization of the lumbar and 
cervical regions of the cord, the pons Varolii, and the 
peduncles of the cerebrum, while irritation of the 
cerebellum alone has no such effect. 1 Eckhard is 
therefore of the opinion that the seat of erection is in 
the cerebrum, and that the nerves which bring about 
erection, starting from the cerebrum, run downward 
in the medulla spinalis. 

Goltz, in his experiments upon dogs, cats, and rab- 
bits, found that erection can be caused by excitation 
of the glans, bladder, and rectum, even after the 
spinal cord has been severed at the upper border 
of the lumbar region, and that it is also possible 
to cause ejaculation of sperma after destruction 
of the lumbar region of the cord, even though 
the capability of erection has been entirely 
extinguished. 2 

The result of these experiments on animals corre- 
sponds with clinical observations in cases of injuries 
and diseases of the spinal cord. Further experi- 

1 Eckhard, op. cit., p. 77. 

2 Goltz, Ueber die Functionen des Lendenmarks des Hundes. 
Pfliiger's Archiv fur die gesammte Physiologie, Band viii, 
Heft 8 u. 9, p. 464. 



60 SEXUAL IMPOTENCE 

ments have shown that in the cerebrum and in the 
upper portion of the spinal cord there must be in- 
hibitory nerves affecting erection; because, after 
section of the cord at the upper border of the lumbar 
region, erection can be caused more easily and more 
vigorously by means of electric irritation. 

We have seen that erection is caused by afflux of 
arterial blood and an obstructed outflow of venous 
blood. Erection cannot, however, be brought about 
by mere compression or ligation of the veins. That 
an increased flow of arterial blood takes place is 
proved by the rising of the local temperature of the 
penis and the lowering of the blood-pressure in the 
neighboring inguinal arteries, and even as far as the 
arteria cruralis, as shown by the manometer. How 
this increased arterial afflux is caused is not yet ex- 
plained. Certainly the acceleration of the heart's 
action which always takes place during sexual ere- 
thism can have but a very slight influence. Possibly, 
the arteries of the penis, in consequence of the sexual 
erethism, become dilated, and thus admit more 
blood. The question is, has this erethism a para- 
lyzing influence on the muscles of the walls of the 
vessels, or is it an invigorating effect, causing the 
contractions to become more energetic and more fre- 
quent, and the arteries to pump, so to speak, a 
greater quantity of blood into the mesh-like spaces 
of the penis? 

Goltz endeavors to explain the act in this way: "I 
share the opinion of those who compare the connec- 
tion of the nervi erigentes with the penis to that of 
the vagus with the heart, or the chorda tympani with 
the vessels of the glandula submaxillaris. The prog- 



PHYSIOLOGY OF THE SEXUAL ACT 6 1 

ress of blood through the penis is considerably 
hindered during the time of physiological rest; for 
then the small arteries of the penis and other vascu- 
lar spaces are in a state of moderate contraction. 
Very likely this state of tension or firmness of the 
vessels of the penis is maintained by the action of the 
small ganglia whose presence in the penis has been 
demonstrated by Loven. The pressure of the in- 
going blood dilates the arteries ; when the resistance 
is removed the blood flows more freely through the 
areolar tissue into the erectile bodies, and puts them 
into a state of turgescence. Being, then, with 
Loven, inclined to consider the peripheral ganglia 
the tonic center of the vessels of the penis, we must 
suppose that the nervi erigentes during their activity 
paralyze or check these ganglia in the same way that 
the vagus checks the activity of the ganglia of the 
heart." 1 Goltz saw this opinion confirmed by 
the fact that he succeeded in proving experiment- 
ally that reflex erection of the penis could be pre- 
vented by a more intense irritation of the nervus 
ischiadicus. 2 

Such experiments, if continued, will no doubt at 
some future time result in a complete explanation of 
the mechanism of erection, though for the present 
the practitioner can obtain but unimportant benefits 
from the above researches. 

Experience teaches us that erection can be either 
caused or checked by different impressions from the 

1 Goltz, op. cit., p. 466. 

2 Compare: Prof. Dr. A. Spina (Prague): Experimentelle 
Beitrage zu der Lehre von der Erection und Ejaculation. 
Wiener med. Blatter, 1897, No. 10-13. 



62 SEXUAL IMPOTENCE 

most varied parts of the body. It is certain, how- 
ever, that the cerebrum is the place of origin of the 
sensations of sexual excitement. With this higher 
center is connected, by intercentral nerve-channels, 
an inferior, mechanical reflex center, which has its 
seat in the lumbar region of the cord, and governs 
the performance of the act of copulation. 1 It is 
probable that from the spinal cord issue some special 
nerves which straighten the erectile vessels or else 
diminish their extensibility. 2 

When erection is accomplished, the penis is in a 
condition that makes penetration possible; its vol- 
ume is increased, it is of the necessary firmness and 
directed upward. This last condition is not caused 
by a contraction of muscles but is due to the cir- 
cumstance that "the dorsal fascia, a sort of ligament, 
is denser and shorter than the one of the lower side." 

Ejaculation. — Coitus ends, for the man, with 
ejaculation, after which the erection gives way in 
most cases. Occasional exceptions occur, however, 
though this is contrary to the usual opinion. With 
particularly vigorous men the relaxation of the mem- 
ber is not so rapid, and an immediate repetition of 
the act is possible, and is actually practised by men 
not particular in regard to cleanliness. The rule, 
however, is that if, after ejaculation, the man contin- 
ues the movements of coitus, it is done generally out 
of gallantry toward the partner; all that the man 
really wants after ejaculation is rest. 

Of coitus it may be said with full justice, "Finis 
coronat opus," for ejaculation, the end of the act, is 

1 Goltz, op. cit., p. 473. 

2 Eckhard, op. cit., p. 80. 



PHYSIOLOGY OF THE SEXUAL ACT 63 

also its most essential and decisive part. The pro- 
cess in ejaculation has been observed to some degree, 
but only in animals. The effect of the friction on 
the sensitive glans is communicated to the musculi 
ischiocavernosi, called by Visale erectores penis, and 
to the musculi bulbocavernosi, which contract and 
convey more and more blood to the glans. This 
superabundance of blood invades the prostate and 
the neck of the bladder also, thus completely closing 
the bladder. By the continued irritation the con- 
tents of the ductus ejaculatorii, the prostata, the 
seminal vessels and the ampullae are expelled, these 
fluids combined constituting the ejaculated sperma. 
It is probable that the muscles of the prostata and 
of the pars membranacea contract first, and then are 
immediately followed by the musculi ischiocavernosi 
and bulbocavernosi, which are much stronger and 
constitute the principal element in ejaculation. 

The center for ejaculation has been proven, by 
Budge, to be at the level of the fourth lumbar ver- 
tebra. It is surprising that Finger 1 heralds the idea 
of such a separate center as if it were a new discovery. 

With the contraction of the prostata begins an in- 
tensely voluptuous sensation, but, in case the move- 
ments of coitus cease here, the ejaculation can be 
retained, which possibility is frequently taken ad- 
vantage of by persons expert in coition. 

Ejaculation takes place also in nocturnal pollu- 
tions. Here the excitation, caused by other condi- 
tions, leads also to a contraction of the muscles, and 
if the sleeper awakes before the musculi ischiocaver- 

1 Die Pathologie und Therapie der Sterilitat. Leipzig, 1898 
p. 6. 



\ 



64 SEXUAL IMPOTENCE 

nosi and bulbocarernosi are contracted, he may pre- 
vent the issue of semen. 

Ejaculation is accompanied by an intensely pleas- 
urable sensation, which is dependent on the exciting 
of the sensitive terminal branches, or rami, of the 
nervus pudendus running out into the glans. A 
number of these rami end in the genital nerve-bulbs. 
The bulbi, irritated by the friction against the 
stretched surface of the glans, covered with delicate 
skin, lead this irritation toward the center. 

Ejaculation, as we have seen, is the physiological 
process by means of which the sperm is sent forth 
toward the orifice of the uterus. 

The Semen. — We must now turn our attention 
finally to the product of the male genital organs — 
viz., the semen. 

Hippocrates considered that the whole body was 
employed in the production of the semen. We know 
that this fluid is a mixture of the products of sundry 
glands within the sexual apparatus of the male, and 
that it consists of the secretions of the testicles, the 
epididymes, the vasa deferentia, the seminal vesicles, 
Cowper's glands, and the prostata. 

Ebner has very thoroughly studied the process of 
the preparation of the sperma in sections of the tes- 
ticles of rats, and found that it proceeds from special 
cells, ending in lobules, and advancing like columns 
toward the inner portion of the canal. The cells are 
called spermatoblasts. 

Within a seminal canal are to be found, at the 
same time, all the different degrees of spermatic for- 
mation; all the forms of development repeat them- 



PHYSIOLOGY OF THE SEXUAL ACT 65 

selves about twice within the space of from ten to 
fourteen millimeters. 

Landois, who worked at the same time and inde- 
pendently of Ebner, obtained the same result. He 
calls these spermatoblasts spermatic ears or spikes. 1 

Many different views prevail with regard to details 
in the preparation or production of sperma, and this 
subject is far from having a satisfactory explana- 
tion. Some results to which von Bardeleben came 
in the course of his researches show that the seminal 
canals contain during childhood two kinds of cells, 
the spermatogoniums, or as the Germans call them: 
"Ursamenzellen," and Sertoli's follicular cells, 
obstructing the lumen completely. During puberty 
the spermatogoniums multiply and form by division 
the spermatocytes, which again are transformed by 
double division into spermatides, and the latter by 
forming a tail into the spermatozoids. 2 

The seminal corpuscles are the product of the tes- 
ticles. Every corpuscle shows three characteristic 
portions — viz., a head, a middle piece, and a tail. 
The head is stained by carmin, and therefore is to be 
considered the nucleus. The middle piece has the 
form of a delicate little rod, or of a cone, and con- 
nects the head with the thread-like tail. This mid- 
dle piece is stained by iodin more than is the head. 
The whole semen corpuscle measures 0.051 milli- 
meter, of which the head forms 0.005 , the middle piece 

1 Landois, Lehrbuch der Physiologie. Wien und Leipzig, 
1893, p. 1012. 

2 Nagel Handb. d. Physiologie, Band ii, Halfte 1, p. 47. For 
detailed information see: Bardcleben's Handb. d. Anat., 1904. 

5 



66 SEXUAL IMPOTENCE 

0.006, and the tail 0.04. In each of these parts are 
finer structures, which can be distinguished only by 
staining and the use of oil-immersion lenses. 1 

The tail is the principal motor organ of these sper- 
matozoa, the mechanism of motion being explained 
differently by different investigators. The energy 
of motion of the individual corpuscles is variable. 
Hensen 2 estimates the time of half an oscillation 
at at least one- quarter of a second during the con- 
tinuance of full vital power. The rapidity of the 
movement forward is between 1.2 and 2.7 millime- 
ters, or, according to others, 3.6 millimeters per 
minute. Foster 3 says 2 or 3 millimeters a minute. 

The semen corpuscles, formed in the testicles, re- 
main there until they are discharged in the usual 
manner of seminal expulsion. It is hard to believe 
that spermatozoids once formed are reabsorbed. 
There are, it is true, some isolated observations which 
seem to support the idea ; as, for instance, Schweiger 
observed spermatozoids of a young ram undergoing 
granular decay; this and Kehrer's experiments in 
applying ligatures to the vas deferens of rabbits are 
well-known cases. Finally, as a curiosity, may be 
mentioned the reab sorption of urine in the bladder, 
described in the British Medical Journal. 4 ' 

1 For further information see the very interesting investiga- 
tions by Martin, Carnett, Levi and Pennington. Univ. of 
Penna. Med. Bui., March, 1902. 

2 Physiologi'e der Zeugung. Hermann's Handbuch der 
Physiologie, Band vi. Theil 2, p. 92. 

3 A Text-book of Physiology. New York, 1897, p. 11 14. 

4 Black, On the Functional Diseases of the Urinary and 
Reproductive Organs. London, 1875, p. 157. 



PHYSIOLOGY OF THE SEXUAL ACT 67 

The question of the absorptive power of the bladder 
has been ventilated cum studio and at times, also, 
cum ira. While Alapy 1 came to the conclusion that 
absolutely nothing can be absorbed by the bladder 
itself, Hottinger's 2 experiments seem to prove the 
contrary. If we remember that a limited absorption 
can be accomplished even by the skin, it is hard to 
understand why the intact bladder should not, under 
favorable circumstances, be able to absorb to some 
extent. 

Dr. Gerota, of Bucharest, 3 showed by a series of 
microscopic plates that, while there was imbibition 
on the part of the mucous lining of the bladder, there 
was no real active absorption. Recent experiments 
by investigators, too numerous to be enumerated, 
prove 4 that the normal bladder, is, to a certain extent 
capable of absorbing liquids and dissolved substances. 
The absorptive faculty is enhanced through lesions 
of the epithelium. Bacteria, however, can penetrate 
into the deeper layers only when the epithelium is 
damaged. 

The philosophical discussions of Gosselin, Haller, 
and others show only that these men had no correct 
conception of the sexual functions of the man. 

To me this theory of reabsorption of semen is com- 
parable to the notion that a cold can be caused by the 
absorption of perspiration, which Hebra, in his lec- 

1 Centralblatt fur die Krankheiten der Harn und Sexual Or- 
gane, 1896, p. 328. 

2 Ibidem, p. 333. 

3 Medical Record, September 18, 1897. 

* Victor Blum. Die Harnvergiftung. Sammlung klin. 
Vortrage, 1904, No. 365, p. 148. 



68 SEXUAL IMPOTENCE 

tures ridiculed whenever an occasion arose. Hen- 
sen 1 says, in referring to the above, "We require 
better proofs to establish a normal decay. Decay- 
ing of elements in the sperma would of necessity be 
so unprofitable, even dangerous, for the race that 
some contrivance to excrete them would long since 
have formed." Hensen thinks that the sperma, be- 
ing slowly formed, will gradually be driven or pushed 
out of the ductus ejaculatorius, in case pollutions 
alone do not favor the continued renewal of sperma. 
Hensen, therefore, supposes a physiological sperma- 
torrhea. This also is an assumption which would 
likewise require demonstration. I myself, during 
the years 1884 to 1888, made observations on this 
subject, and, although they may not constitute a 
conclusive argument against Hensen' s assumption, 
I will state them as an incentive to further inves- 
tigations. 

During two years I have, with special care, repeat- 
edly examined the urine and urethral mucus of two 
perfectly healthy and vigorous men, aged twenty- 
nine and thirty-four, who were absolutely continent 
and had had no seminal emission ; and I have never 
found even a trace of spermatozoids. The younger 
of these men, a clergyman, submitted to this exami- 
nation on account of a friendship of long standing 
between us and his love of science. Before the first 
discharge of urine in the morning, for seventy-five 
successive days, I examined carefully, with the mi- 
croscope, the urethral mucus, which was small in 
quantity, and then every discharge of urine; but 

1 Op. cit., p. 93. 



PHYSIOLOGY OF THE SEXUAL ACT 69 

never found as much as a trace of a spermatozoid. 
I lay especial stress upon this as opposed to the as- 
sertions of Black, 1 who states that he had frequently- 
found seminal filaments in the urethral mucus after 
alvine evacuations in healthy men. 

The other of the above-mentioned men, thirty-four 
years of age, had been married, but his wife died of 
phthisis six years before I began my observations 
upon him. He had lost his two children by diph- 
theria in the same year. The unfortunate man grew 
melancholy and for some time felt no sexual desire. 
Later on he had pollutions and violent sexual desires ; 
but he overcame them, and after four years of 
absolute continence he seldom had erections in the 
mornings, and thought no longer of sexual passions. 
He asserted that formerly he had been vigorous in 
coitus and had indulged daily. 

The twenty-nine-year-old man had masturbated 
at wide intervals from the age of sixteen to twenty- 
three. He struggled against this "sinful practice," 
as he called it, with all the power of his exceptionally 
strong character. He finally mastered his passion. 
For two years his occasional pollutions grew less fre- 
quent, and for three years past he has had no emis- 
sion of sperm in any way; sexual desire visits him 
seldom, though he has erections every morning. 

Still more characteristic is the following observa- 
tion. A professor at a university, thirty-nine years 
old, and of large and powerful build, has been mar- 
ried for fourteen years, enjoying good health. His 
wife, often sickly, disinclined to sexual intercourse, 

1 Op. cit., p. 63. 



70 SEXUAL IMPOTENCE 

is absent for months; hence a forced continence for 
long periods. As soon as this goes beyond a month 
there appears a slight but painful swelling of the tes- 
ticles. He finds himself compelled to indulge in 
sexual congress at any cost, during which he emits 
unusually large quantities of sperm, and the swelling 
and pain in the testicles vanish as if by magic. 

I claim no conclusive credit for the above three ob- 
servations; but they, together with a number of 
others, of which I may have to speak in connection 
with impotence as a result of continence, confirm me 
in the opinion that sperm once formed will, if it is not 
expelled in any of the usual ways, at first hinder, and 
finally stop, the production of new semen. It would 
indeed be interesting to know what becomes of this 
stored-up semen. The only chance for clearing up 
this question would seem to be an autopsy of persons 
who, after long continence, have died suddenly; but 
such an opportunity will seldom be offered. The 
third observation of these three individuals seems to 
prove that, in some cases of continence at least, the 
production of semen is not only not retarded but ac- 
tually increased, so that the accumulation of sperm 
becomes so great that it causes the testicles to swell 
and become painful. Systematic examinations 
of centrifuged urines, made at my laboratory by 
J. Henderson, seem to support my early conclu- 
sions. 

What is commonly called semen consists of the 
spermatozoids, formed in the testicles, to which are 
added the secretions of several glands situated in 
the terminal portion of the vasa deferentia, the so- 



PHYSIOLOGY OF THE SEXUAL ACT 7 1 

called ampulla; there is added also the secretion of 
the walls of the vesiculae seminales. The latter are 
not real glands but canals ; their inner surface is much 
increased by folds and villi, and their secretion helps 
mostly in diluting the sperm. 

It does not seem to me satisfactorily determined 
whether the vesicula seminales are secreting glands 
or merely receptacles for the sperm. The new ex- 
perimental researches about the physiology of the 
seminal vesicles by Rehfisch 1 are very interesting, 
but do not reveal any important or new points. It is 
probable that the vesiculae seminales and the am- 
pullae of the vasa deferentia have two functions — 
viz., to serve as receptacles, and to produce an al- 
buminous secretion that attenuates the sperm. The 
contents of the ampullae and of the vesiculae semi- 
nales of fresh cadavers have all the characteristics of 
ejaculated sperm, but are poorer in spermatozoids. 
Henle 2 endeavors to explain this fact by supposing 
that at the last moment of coitus that portion of the 
vas deferens nearest to the ampulla evacuates its 
contents more quickly. 

We know that the left testicle is slightly larger 
than the right one, in the same proportion is the left 
seminal vesicle larger than the right one. The cir- 
cumstance that in cases of atrophy of one testicle we 
always find atrophy of the seminal vesicle on the cor- 
responding side, certainly speaks for the assumption 
that they are mainly a storing receptacle for semen. 

Extirpation of the seminal vesicles did not dimin- 

1 Deutsche med. Wochenschrift, 1896, No. 16. 

2 Op. cit., p. 389. 



72 SEXUAL IMPOTENCE 

ish the sexual instinct in white rats, though their 
procreative power seemed impaired. * 

As stated before the importance of the ampulla 
is not being properly realized. Pathological changes 
in this small organ are frequently the cause of ejacu- 
latio precox. 

To the semen, attenuated as above described, is 
later added the secretion of the prostata and of Cow- 
per's glands. 

Eckhard obtained by irritation, from the prostata 
of a dog, a secretion which had the specific gravity of 
1.012, one per cent, of albumen and 2.4 per cent, of 
solid constituents. 

The relation of the prostata with its secretion to the 
semen is not clearly demonstrated. Henle 2 is quite 
right when he says that the seminal fluid in the 
ampullae of the vasa deferentia and in the vesiculae 
seminales, although closely resembling the ejaculated 
semen, is poorer in spermatozoids. Hence what 
needs explanation is not an attenuation of the semen, 
but an actual increase in spermatozoids. Henle says 
further: "It is scarcely reasonable to suppose that 
the function of the prostata is to attenuate the semen 
as the principal mouths of the prostatic ducts are sit- 
uated behind the summit of the colliculus seminalis, 
and the latter seems to shut off the urethra during 
erection. Finally, as far as my knowledge extends, 
the concentric concretions, which are seldom want- 
ing in the glandula prostatica of old men, and which 

1 Nagel's Handb. d. Physiologie, p. 60. 

2 Op. cit., p. 401. 



PHYSIOLOGY OF THE SEXUAL ACT 73 

are often found in the outlets of the prostata, are not 
found in the ejaculated semen." 

Henle asked : "Is the prostata connected perchance 
with erection, and does it furnish the mucous fluid 
which oozes from the mouth of the urethra after con- 
tinued erection?" The reaction of the prostatic 
secretion has, according to Lohenstein 1 and Casper's 
convincing arguments, no influence upon the vitality 
of the semen. Posner as usual mistook one thing for 
another, and he must not be surprised when authors 
neglect to register all his self-styled physiological 
discoveries. The secretion of the prostata, however, 
seems to play some part in coitus, because the whole 
gland remains undeveloped in castrated animals. 
Walker 2 came to the conclusions that the immediate 
production of the motility of the spermatozoids is 
induced by a thinning of the testicular secretion with 
the prostatic juice, and that the continued move- 
ment is probably kept up by substances in the 
prostatic fluid, that either act as stimulants or as 
food for the organisms. 

We must agree with Reynolds 3 when he says: 
"What the exact function of the prostate is we are 
unable to say definitely." 

It is certainly very significant that "the vasodi- 
lation of erection is accompanied by a vasodilation 
of the prostate. 4 We shall have occasion to return 

1 Verein fiir innere Medicin in Berlin, Oct. 15, 1900. 

2 Walker, op. c. 

3 Walter S. Reynolds. Am. Jour, of Urol., Jan., 1906, p. 
354- 

* Ott, op. c. 



74 SEXUAL IMPOTENCE 

to the important question of the functions of this 
extremely interesting organ. 

Finally, it is held that the mucus of Cowper's 
glands unites with the sperm, but Henle 1 thinks that 
Cowper's glands do not add their secretion to the 
sperm, and are, therefore, not to be reckoned among 
the organs of the sexual apparatus, but of the urinary 
apparatus. Beyond doubt these glands, together 
with the mucous glands proper of the urethra, make 
provision for the moisture and lubricity of the ure- 
thra, and thus, in any case, aid in ejaculation, and 
perhaps, as Hensen 2 conjectures, clear the urethra of 
remains of urine, which have an acid reaction and 
kill the spermatozoa. Besides this, we must not 
forget that Cowper's glands are perfectly developed 
in infancy and in eunuchs. 

Let us direct our attention now to the ejaculated 
sperm. The quantity and quality vary greatly in 
different individuals, as well as in the same individ- 
ual, the differences being determined by the varia- 
ble productiveness of the glands, which differ in the 
same manner and degree as their products, for rea- 
sons, some known and some unknown. 

Mantegazza 3 finds the quantity of ejaculated 
semen of a thirty-year-old man weighing, about 
eighty kilograms, to be between 0.75 and 6.0 cubic 
centimeters. Ultzmann 4 estimates the average 

1 Op. cit., p. 413. 

2 Op. cit., p. 101. 

3 Ricerche sullo sperma umano. Gazzetta medica Italiana 
Lombardia, 1886, Nr. 34. 

4 Ueber Potentia generandi und Potentia coeundi. Wiener 
Klinik, 1885, Heft 1, p. 2. 



PHYSIOLOGY OF THE SEXUAL ACT 75 

quantity for a moderately living man at ten to 
fifteen grams. 

It is to be regretted that, in connection with the 
above figures, there are no indications how these ejac- 
ulations have been brought about, because those 
from involuntary night-emissions, are considerably 
less in quantity than those in coitus. This fact, which 
I was first to note, may be explained in this way : the 
vesiculse seminales and spermatic ducts do not always 
empty their contents into the urethra at the same 
time, and it may be that when the excitation is 
moderate only one of the receptacles empties itself. 1 

The measuring of the quantity ejaculated during 
coitus is an impossibility, since the quantity is less 
when the coitus is prematurely stopped or inter- 
rupted, as in the cases known as "frauding," or " coi- 
tus interruptus." This may explain why the so- 
called "fraudeurs" can at first accomplish coitus 
oftener than those who follow nature, and why the 
same individual when he begins frauding can repeat 
the act more frequently than when he does not cheat 
nature in this way. The bad effects of frauding, 
also, which Bergeret 2 paints in colors decidedly too 
gloomy, may here find their explanation. There are 
cases, nevertheless, where long-continued frauding 
has undoubtedly weakened the sexual sense. I have 
observed this repeatedly within the last few years. 
The sexual sense, however, soon recovers when 
frauding is discontinued. 

1 Landois, op. cit., p. 1024. 

2 Des fraudes dans l'accomplissement des fonctions genera- 
trices. Paris, 1884. 



*j6 SEXUAL IMPOTENCE 

The ejaculated sperm is a colorless, opalescent 
fluid, in appearance resembling boiled starch. The 
seminal filaments on their way from the testicles to 
the meatus urinarius externus are joined by the 
products of sundry glands, and thereby assume cer- 
tain characteristics, the odor of chestnut-blossom or 
newly sawn bones being peculiar to the main sub- 
stance formed in the testicles. Nagel, 1 however, 
thinks that this odor is due to the spermin which is 
produced in the prostate gland. It is very interest- 
ing and most significant that spermin is also found in 
the testicles, the ovaries, the pancreas, spleen and 
thyroid gland. 

The alkaline reaction comes, possibly, from the 
secretion of the prostata ; the color, from the admix- 
ture of the secretion of the vesiculae seminales; the 
gluey consistency, from the secretion of Cowper's 
glands. 

The seminal liquid is heavier than water, soluble in 
water and acids, and coagulable by alcohol. Color- 
less, brittle crystals separate from it when it has been 
standing for a long time, the process being somewhat 
more rapid when the sperm has been placed in ice, or 
when inspissated. These crystals are compound 
phosphates containing an organic base. 2 Vauque- 
lin's chemical analysis is as follows : 

Water 90 

Organic substance, mucin 6 

Earthy phosphates 3 

Sodium chlorid 1 

1 Op. cit., p. 48. 

2 Foster, op. cit., p. 1115. 



PHYSIOLOGY OF THE SEXUAL ACT 77 

The solid matter contained in the semen is mostly- 
furnished by the spermatozoa. The head of a sper- 
matozoon appears to be largely composed of the body 
or group of bodies known as nuclein or nucleo-albu- 
min, a result which supplies chemical evidence of the 
nuclear nature of the spermatozoon head; and nu- 
clein forms a considerable portion of the solid matter 
of the whole semen. Lecithin and cerebrosid, 
closely related to the cerebrin are also present in 
considerable quantity in the semen. 1 

The consistency of the sperm changes soon after 
ejaculation, becoming more nearly liquid. 

Whether or not a fluid is sperm can be proven only 
by microscopic examination. Sperm under the mi- 
croscope shows seminal corpuscles, granules, cells, 
and epithelia from the prostata and urethra. If 
the sperm comes from coitus, it also contains pave- 
ment epithelium from the female genitals. 

Each cubic centimeter of ejaculated semen is said 
to contain 60,000,000 to 70,000,000 spermatozoa. 2 

Frequent indulgence will both diminish the quan- 
tity and impair the quality of the sperma. Differ- 
ences have been observed in this with respect to indi- 
viduals and to time, and I can myself assert as a 
result of numerous observations that habit and 
sexual vigor are the main agents producing such 
differences. 

The presence of spermatozoa determines the fer- 
tilizing power of the semen. The sperma of a vigor- 
ous man in a state of perfect virility shows under the 

1 Ibidem. 

2 Howell, A Text-book of Physiology, Saunders, Philadelphia and 
London, 1913, p. 969. 



78 SEXUAL IMPOTENCE 

microscope a very animated life picture, which Ultz- 
mann quite appropriately compares to the life exhib- 
ited by an ant-hill. The spermatic filaments are seen 
to shoot across the field of vision like arrows, making 
movements that seem anything but aimless, so that 
it is not to be wondered at that they were formerly 
thought to be animalcules. 

This animation is most lively in newly ejaculated 
semen, and grows calmer in proportion as the sperma- 
tozoa die; but, if the sperma be preserved under 
favorable circumstances, some of the filaments may 
be seen alive even at the end of forty-eight hours. 
They are killed by urine and the vaginal mucus, hav- 
ing an acid reaction. Mantegazza 1 found that the 
spermatozoa retain their vitality in temperatures 
varying from 15 to 47 C. Heating above 47 or 
freezing below 15 kills them. It was further dis- 
covered that these filaments remain vital in frozen 
semen as long as six days, possibly even longer. 
In an incubator kept at normal blood temperature 
they can retain their vitality up to eight days, and 
Diihrssen 2 found them in the female sexual organs 
motile even after three weeks and a half. Slightly 
alkaline fluids, such as blood, favor the life of the 
spermatozoids. Such fluids, as well as concentrated 
solutions of salt, sugar, and albumen, are capable 
of reviving spermatozoids that are already motion- 
less. Water destroys motion after an hour, at the 
latest; but they are very lively in purulent sperm; 
consequently they are not affected by pus. 

In dead spermatozoids the lifeless tail is found in 

1 Loc. cit. 

2 Nagel, Op. cit., p. 54. 



PHYSIOLOGY OF THE SEXUAL ACT 79 

various positions. In spermatozoids that die after 
ejaculation the tail is stretched out or slightly bent, 
while in those that are ejaculated dead it is spirally 
wound up, but seldom broken. 

Most authors adduce various experiments, the re- 
sults of which have led to an opinion not wholly cor- 
rect — viz., that frequent coition reduces the number 
of spermatozoids, and daily coition makes them dis- 
appear altogether. To these investigators I can op- 
pose many observations, where, after coition re- 
peated daily several times, the sperma still contained 
numerous spermatozoids. These observations were 
made in the years 1 884-1 888. The differences in 
the results of the observations can easily be explained, 
inasmuch as examinations made on old men lead to 
different conclusions from those made on vigorous 
and perfectly virile young men. 

Even so modern an author as Draper 1 reiterates 
the same old errors, though, when treating on an 
other subject he warns against the acceptance of 
all sorts of inheritance " handed down from author 
to author" and says: "It is well to test the value 
of authority, ..... by new investigations from 
time to time." 2 

Before I refer to some of my own observations, I 
wish to observe that of necessity it has not always 
been possible to make the microscopic examinations 
immediately after coition, nor at an equal length of 
time after copulation; and, furthermore, the fre- 
quency of coition could not be regulated by the 

1 A Text-book of Legal Medicine. Saunders, Phila. and 
London, p. 144, 1905. 
a Draper, Op. cit., p. 133. 



80 SEXUAL IMPOTENCE 

investigator. The sperma was invariably taken in 
the largest quantities possible, and was preserved in 
glass tubes, which were sealed and so placed that 
neither air nor light could affect the contents. All 
the microscopic examinations were made with a No. 
3 ocular and a No. 7 objective of a Wetzlar micro- 
scope. 

OBSERVATIONS ON SUBJECT NUMBER ONE. 

A vigorous and perfectly healthy man, twenty- 
nine years old, who performed coition on an average 
once a day. The microscopic examinations gave the 
following results : 

From October 1 to October 9 one coition per day ; 
on October 9, examination of sperma nine hours after 
coition; result, few spermatozoids, mostly dead, not 
well developed; but the few still moving are very 
lively, although mostly young forms. 

October 10. — One coition; sperma not examined. 

October 11. — Sperma examined eleven hours after 
coition; result, few spermatozoids, all dead. 

October 1 2 . — Examination nine hours after coition ; 
no spermatozoids. 

October 14. — Coition after a lapse of forty-nine 
hours; examination eight hours afterward; result, 
about thirty spermatozoids, few alive, movement 
slow but very energetic. The coitus having been 
performed with a woman whose menses had begun, 
there is a blood-corpuscle (I could never discover 
blood-corpuscles in the ejaculations of so-called 
continent persons, as reported by Richard 1 ) ; a few 

1 Histoire de la generation. Paris, 1883, p. 159. 



PHYSIOLOGY OF THE SEXUAL ACT 8 1 

seminal filaments join the blood-corpuscle, but, after 
a momentary effort, push the corpuscle aside. 

October 17. — Coitus after forty-eight hours' rest; 
examination eight hours later; result, about fifty 
dead filaments. 

October 18. — Coitus after sixteen hours' rest; ex- 
amination sixteen hours later; result, many sperma- 
tozoids had died, a few had been ejaculated dead. 

On the same day, the sperm of a coitus, being the 
third within twenty-four hours, was examined ten 
hours after coition; result, very numerous sperma- 
tozoids, movement very energetic and as if with a 
purpose in view. 

October 20. — One coition after an interval of forty- 
eight hours; examination ten hours after; result, 
fifty spermatozoids, all dead but a few. Second coi- 
tion, one hour after first; examination nine hours 
later; result, spermatozoids very numerous and ex- 
ceedingly lively ; scarcely one-third had died. 

October 21. — Coition after an interval of twenty- 
three hours; examination eight hours later; result, 
numerous spermatozoids, all living. 

October 22. — Coition after sixteen hours' rest; ex- 
amination sixteen hours later; result, fewer sperma- 
tozoids ejaculated alive, and, with few exceptions, 
all had died prior to my examination. 

October 23. — Coition after thirty hours' rest; ex- 
amination seventeen hours later; result, very many 
spermatozoids, but nearly all had died ; besides a few 
ejaculated dead. 

Similar results from examinations of sperm from 
same individual on October 24 and 25. 
6 



82 SEXUAL IMPOTENCE 

October 28. — Coition after sixty-four hours' inter- 
val; examination eight hours later; result, about 
sixty spermatozoids, which had nearly all died, but 
one-third of them had been ejaculated dead. 

October 29. — Coition after six hours' rest; exami- 
nation two, hours later; result, very numerous, ac- 
tive spermatozoids, only a few ejaculated dead; very 
few had died.' 

October 31. — Coition after fifty-eight hours' inter- 
val; examination sixteen hours later; result, sper- 
matozoids few in number, nearly all ejaculated dead; 
the rest had died. 

November 1. — Coition after fifteen hours' rest; ex- 
amination one hour later; result, rather more sper- 
matozoids, nearly all alive, though not moving with 
energy; others ejaculated dead. 

On same day, a second coition after fifteen hours ; 
examination ten hours later; result, spermatozoids 
numerous, lively, only a few ejaculated dead. 

SECOND SUBJECT FOR OBSERVATION. 

Powerful man, thirty years old, healthy, though 
inclined to obesity; enjoying life, very vigorous in 
sexual matters, and observes no rule at all; offers 
himself for ten days' observation. 

February 10. — Coition after forty-one hours' in- 
terval; examination ten hours later; result, sperma- 
tozoids few in number, but moving with energy ; few 
ejaculated dead, few died after ejaculation. 

Same day, second coition, one hour later; exami- 
nation nine hours after; result, spermatozoids very 
numerous, lively, and moving energetically; with- 



PHYSIOLOGY OF THE SEXUAL ACT 83 

out exception ejaculated alive, and only very few had 
died. 

February n. — Coition after twenty-three hours' 
rest; examination ten hours later; result, spermat- 
ozoids less numerous ; some moving, some had died, 
the rest ejaculated dead. 

February 13. — Coition after an interval of forty- 
three hours; examination fifteen hours later; result, 
spermatozoids very few and most of them ejaculated 
dead ; none moving. 

February 14. — Coition after thirty hours' rest; ex- 
amination and result, same as February 13. 

February 15. — Coition after seventeen hours' rest; 
examination sixteen hours later; result, spermat- 
ozoids numerous, moving energetically. 

Same day, second coition six hours later; exami- 
nation ten hours afterward; result, spermatozoids 
not very numerous, but movement lively; most of 
the forms young; none were ejaculated dead. 

February 17. — Three coitions within six hours; 
spermatozoids of the third coition examined ten 
hours after; very numerous, some of them still mov- 
ing with energy; many had died, only few were ejac- 
ulated dead. 

February 18. — Coition after eleven hours, there- 
fore fourth coition within seventeen hours; exami- 
nation one hour after; result, spermatozoids less 
numerous, but moving with great activity and 
energy; few ejaculated dead, almost none died after 
ejaculation. 

February 19. — Coition after fifteen hours ; exami- 
nation ten hours later; result spermatozoids extra- 



84 SEXUAL IMPOTENCE 

ordinarily numerous, very well developed, with ener- 
getic and lively motion; none ejaculated dead, and 
only isolated ones had died. 

THIRD SUBJECT FOR OBSERVATION. 

Age not quite thirty, healthy and vigorous, life 
very active, but finds time to enjoy it, and makes 
best use of his leisure hours for venery. 

After fifteen days' abstinence, intercourse four- 
teen times within six days. The last ejaculation ex- 
amined scarcely one-quarter hour after; result, sper- 
matozoids very numerous, many well developed, 
moving with energy and vivacity. The field of 
vision shows the picture that Ultzmann compared to 
an ant-hill. 

From these observations and many more I have 
made, it may be concluded that, with persons who 
have accustomed themselves to frequent intercourse 
and have the power to do so, the number of spermat- 
ozoids increases to a certain limit with the fre- 
quency of coition, instead of decreasing, as sup- 
posed by the older authors. It may be concluded 
also that the spermatozoids become very numerous, 
well developed, lively, and energetic only when 
coition is repeated. 

It is difficult to say to what this phenomenon is 
due, though it is probable that the sperm of the vesi- 
cular seminales, which is poorer in spermatozoids, is 
evacuated first, and that only after that, by the repe- 
tition of coition, come the contents of the vasa def- 
erentia, and last of all those of the testicles. This 
circumstance may be of special importance in the 
consideration of certain cases of sterility. 



PHYSIOLOGY OF THE SEXUAL ACT 85 

Furthermore, such results justify the supposition 
that the spermatozoids which enter the vesiculse 
seminales for storage lose their vitality in that canal 
gradually. According to the results of my observa- 
tions, however, they lose it rather quickly. I am 
still further confirmed in this belief by the fact that, 
although I have very often had the chance to ex- 
amine the semen from nocturnal emissions, some- 
times within an hour after such emission, I have sel- 
dom found living spermatozoids in such sperma. 
Most of the spermatozoids, which were often found 
in great numbers, looked as if they had been ejac- 
ulated dead, while only few had the appearance of 
having been ejaculated alive and of having died on 
account of their low vitality. I must not omit the 
observation that the first portion of a pollution 
scarcely ever contained a living spermatozoid, while 
the second was more likely to show living forms. It 
is possible, but not proven that, as Furbringer, 
Burckhart and Finger assert, the spermatozoa con- 
tained in vesiculse seminales are motionless until the 
secretion of the prostata is added to them. 

In my numerous" microscopic examinations of 
sperm I have made a few more discoveries, which I 
shall here adduce briefly. The energy of movement 
of a spermatozoon is most easily determined by gen- 
tle pressure on the cover-glass, which causes a cur- 
rent in the small quantity of seminal fluid between 
the two glass disks. If there are any spermatozoa 
moving with energy, they will swim unaffected by 
the current, and continue in their original direction, 
some swimming against the current. 



86 SEXUAL IMPOTENCE 

The forward movement of the spermatozoids 
seems to me not to be produced by a whip-like motion 
as has been stated. "The movements are of an 
undulatory character, the waves traveling from the 
middle-piece to the end of the tail." 1 It seems to 
me rather a regular, rudder-like action on the part 
of the tail. This action is seen plainly when a 
dying spermatozoon is watched; the movements 
grow slower and slower until they gradually cease 
altogether. 

It is very interesting to watch how spermatozoa 
often meet with premature death. A spermatozoon 
swimming along quite energetically suddenly strikes 
some obstacle ; the tail finds itself caught between 
masses of detritus, fragments of cells; the spermat- 
ozoon makes desperate efforts, moves spasmodic- 
ally, and seems thus to use up all its vital power in a 
short time, as it quickly dies. Sometimes the sper- 
matozoon succeeds in disengaging itself, but usually 
it suffers some injury. I once saw one with a sharp 
bend in the tail close behind the head swim on in a 
lively manner. 

Foster, op. cit., p. 1114. 



CHAPTER III. 

ETIOLOGY OF IMPOTENCE. 

Among the circumstances that determine sexual 
vigor the foremost of all is the structure of the geni- 
tals. Here we shall not take into consideration ab- 
normal formations, as they will be treated specially, 
but shall limit our attention to genitals anatomically 
normal.. 

The appearance of the genitals varies considerably 
as regards size, form, and color. The differences are 
noticeable even in childhood, in which case they can- 
not be ascribed to extraneous causes. Small geni- 
tals are always a sign of insignificant sexual power, 
while large ones, remaining in proportional size dur- 
ing erection, indicate great power. There are geni- 
tals which during sexual repose show large dimen- 
sions, but which are flabby and appear large only in 
consequence of the extent of the vascular meshes of 
the cavernous tissue, and do not grow larger propor- 
tionally by the rilling with blood during erection. In 
such genitals erections do not occur readily, and they 
accordingly indicate anything but sexual vigor. 
Such qualities belong to genitals of the aged and to 
sexual organs which owe their size to sexual excesses 
committed before puberty. 

Together with the necessary dimensions the tex- 
ture of the penis must possess firmness. The testicle 
must be sufficiently large, firm, and insensible to 
slight pressure. 

87 



88 SEXUAL IMPOTENCE 

Besides this, the vascularity of the genitals is of 
importance. A pinky, transparent cutis of the glans 
and warmth of the penis indicate that a sufficient 
quantity of blood is present. A pale glans and a 
penis that feels cool indicate local poverty of blood 
as well as sexual weakness. 

Finally, the excitability of the nerve-ends that spread 
in the glans is of consequence with regard to the 
qualities of the genitals. Where the glans is entirely 
covered by the prepuce its surface is very sensitive. 
Such subjects answer quickly to external excitation, 
but are seldom noted for their power, as coition lasts 
too short a time, and they are inclined to what is 
called irritable weakness. If the glans is covered by 
the prepuce only partially or not at all, its epidermis 
grows harder and less sensitive; external excitation 
affects tardily; a greater amount of irritation is re- 
quired to complete the coitus, and the sexual organs 
themselves become more inclined to insensibility, 
which becomes more noticeable in riper age, when 
the central excitations grow fewer by degrees. Innate 
as well as acquired advantages or defects in the for- 
mation of the sexual organs influence their capabil- 
ity of action advantageously or otherwise. 

Stronger pigmentation in the sexual organs is gen- 
erally accompanied by greater capacity in venery, 
which fact is seen in negroes, who are, as a rule, en- 
dowed with large genitals. The well-known rule 
that brown-haired men have usually more sexual 
power than light-haired ones is admissible only in the 
comparison of men of the same race. 

The bodily structure of a man is of the utmost 



ETIOLOGY OF IMPOTENCE 89 

weight with respect to his sexual capacity. It is 
self-evident that an individual who is in every re- 
spect healthy and vigorous will accomplish more in 
sexualibus than one sickly and weakly. Apparent 
anomalies are not wanting, and, indeed, we see often 
enough that decrepit and cachectic individuals com- 
mit considerable excesses in venery; but in the long 
run the weakling and the sick man will suffer more or 
less disaster, and only an energetic metabolism can 
for any length of time enable one with any effect to 
resist the manifold ravages of lavishing semen. 

Due weight must here be allowed also for heredi- 
tary predisposition. There are families in which all 
the male members are distinguished for great sexual 
power; whereas the contrary may be noticed often 
enough in other families. I can only agree with Mor- 
row 1 when he says, "The important role which 
heredity plays in determining disorders of the genital 
function has not been fully recognized nor suffi- 
ciently emphasized by writers upon the subject." 
Indeed, I expressed the same views years ago. 2 Idio- 
syncrasy, in fact, all the psychical qualities of a man 
powerfully influence his sexual capacity. 

Of great importance also is the age. Some authors 
allow a greater, others a lesser, latitude. There are 
severe moralists who will not allow sexual enjoy- 
ment before a man has completed his twenty-fifth 



1 Functional disorders of the Male Sexual Organs. A System 
of Genito-Urinary Diseases, Syphilology, and Dermatology. 
New York, 1893, vol. i., p. 1001. 

2 Pathologie und Therapie der Mannlichen Impotenz. Wien 
und Leipzig, 1889, pp. 45, 73-83. 



90 SEXUAL IMPOTENCE 

year, and who say that he must be moderate even 
then, and desist from it when he is fifty years old. 

The vast difference in the opinions held upon this 
subject evidently proves that no fixed rule can be 
laid down. Most authors have committed the error 
of allowing their personal experience to act as a cri- 
terion. The following general principles may, how- 
ever, be stated : 

Nature alone indicates the time when a man should 
satisfy sexual desire. The course of nature should 
in nowise be interfered with or anticipated. When 
nature has done her work of bringing the man to ma- 
turity, when the testicles have produced sperm, and 
that sperm is thrown out by involuntary emissions, 
when the youth's whole being is undergoing a radical 
change, then I cannot understand why he should not 
satisfy that impetuous, irresistible longing; why he 
should be condemned, in the best part of his life, to 
become an onanist or to lose his power by pollutions. 

Virility generally begins when the man reaches the 
age of eighteen years, increasing until he has reached 
his fortieth year. From that time it begins slowly 
but steadily to decrease, until in his sixty-fifth year 
it is usually extinguished. There are some who in 
their sixteenth year, and even before, are perfectly 
fit for coition, and a great many who preserve their 
sexual power to an advanced age; whereas, on the 
other hand, some hardly enter into puberty at the 
age of twenty-four, and are overcome by senile im- 
potence before they are fifty years old. 

Besides these congenital qualities, over which the 
individual has no control, there are many circum- 



ETIOLOGY OF IMPOTENCE 9 1 

stances generally beyond his control also, but which 
he may, nevertheless, endeavor to bring about so as 
to influence his virility more or less. 

Here we must, first of all, mention acquired de- 
formities and diseases of the genitals or other organs ; 
after that the manner in which one husbands the 
gifts of nature. Too much indulgence may be just 
as injurious as too little. Furthermore, there must 
be taken into account the influence of nutrition, of 
certain alimentary or medicinal substances, and of 
occupation and habits. Finally, there are many 
other things that have more or less influence on the 
strength of a man in sexual matters, and their con- 
nection with virility seems peculiar and strange be- 
cause we cannot understand it. 

It would surely lead into trouble should we en- 
deavor to consider dreams and subsequent "dormant, 
forgotten complexes" or so-called "soul happenings' ' 
as etiologic factors of sexual impotence. While my 
personal experience teaches me that Freud goes too 
far, I am sure that his theories cannot be disposed of 
easily, and even Dercum 1 couches his adverse judg- 
ment diplomatically by saying that " dreams are 
probably always symptomatic and never casual." 
The etiology of every single case of so-called psychic 
impotence is of the greatest importance, and we 
must always be on the look-out by scanning the 
patient's past sexual life, and prying even into his 
dreams. 

The varying influence of seasons, for instance, mod- 
ifies the sexual power, though this cannot be ac- 

1 Journ. Am. Med. A., May 13, 1911, p. 1377. 



92 SEXUAL IMPOTENCE 

knowledged unconditionally. Everybody knows 
that man is given to love in spring more than in any 
other season. Some French investigators (such as 
Villerme, Quetelet, and Smits) have worked out 
tables in which the order in which the months are 
named is indicative of the number of conceptions 
that occurred therein; but they cannot be accepted 
as valid, because such proofs, based on statistical 
calculations, are not always independent of chance. 
Nor can we accept as an absolute proof the fact that 
most crimes against morality are committed in the 
spring; as here, too, many other social conditions 
must be taken into consideration. M. Perry-Coste 
and M. Fere have published two cases of sexual 
periodicity, and M. G. Loisel (Academie des Sci- 
ences, Paris, October 29, 1900) tried to explain 
the fact by assuming spermatogenetic phases. I 
would rather agree with Kisch who sees in this 
phenomenon an atavistic tendency. 

Besides the influence of season, we must bear in 
mind the momentary disposition and the varying 
feelings of inclination and disinclination, to which we 
cannot deny a rather strong control over virility. 

After this brief enumeration of the most important 
circumstances capable of influencing sexual virility, 
we may pass on to a description of the individual 
forms of impotence. 

A classification of the manifold forms of this dis- 
ease, which has hitherto received so little attention, 
offers, for the present, insurmountable difficulties. 

Krafft-Ebing's schema 1 of all the sexual neuroses 

1 Psychopathia sexualis. Stuttgard, 1890, p. 24. 



ETIOLOGY OF IMPOTENCE 93 

was very ingenious. He distinguished three kinds. 

They are — 

I. Peripheral neuroses. 

i. Sensory. 

a. Anesthesia. 

b. Hyperesthesia. 

c. Neuralgia. 

2. Secretory. 

a. Aspermia. 

b. Polyspermia. 

3. Motor. 

a. Pullutions (spasm). 

b. Spermatorrhea (paralysis). 

II. Spinal neuroses. 

1. Affections of the erection center. 

a. Irritation. 

b. Paralysis. 

c. Inhibition. 

d. Irritable weakness. 

2. Affections of the ejaculation center. 

a. Abnormally easy ejaculation. 

b. Abnormally difficult ejaculation. 

III. Cerebral neuroses. 

1. Paradoxia. 

2. Anesthesia. 

3. Hyperesthesia. 

4. Paresthesia. 

Ingenious as this classification is, it is of no practi- 
cal use for our purpose. 

Furthermore, Eulenburg 1 considers that differ- 

1 Sexuelle Neuropathie. Leipzig, 1895, p. 44. 



94 SEXUAL IMPOTENCE 

ences between " peripheral neuroses" and "spino- 
f eric neuroses ' ' of the genitals can hardly be deter- 
mined except on paper. This is certainly neatly 
expressed, and holds good also with reference to 
Eulenburg's division of the sexual neuropathic 
phenomena, or with reference to any other possible 
or impossible division: they all look well on paper, 
but, in reality, chaos reigns. 

There are, as we have seen, many causes that may 
lead to impotence ; and although it is always reduci- 
ble to partial or complete failure of erection, yet the 
accessory circumstances accompanying this main 
moving force are often various, according to the ex- 
citing cause. In consequence of this, the disease 
may present to a careful investigator very different 
aspects, and therefore will demand also very dif- 
ferent forms of treatment, determinable by the 
actual causes. 

The usual division of impotentia cceundi into an 
organic form, a psychical form, a form depending on 
irritable weakness, and a paralytic form is surely not 
sufficient, because there are so many varieties that 
cannot be forced into such a frame. 

Beard 1 distinguishes the following forms: 

i. Slight deficiency, both of desire and capacity. 

2. Deficiency of capacity with increase of desire. 

3. Profound deficiency both of desire and capacity. 

4. Erectile power increased abnormally, but no 
discharge of seminal fluid. 

1 Beard and Rockwell, Sexual Neurasthenia, fifth edition. 
New York, 1898, p. 124. 



ETIOLOGY OF IMPOTENCE 95 

Mantegazza 1 distinguishes even as many as ten 
degrees or grades of sexual capacity, but avoids the 
exceedingly difficult task of a classification of the dif- 
ferent forms of impotence. 

I have tried to classify the different forms of sexual 
impotence from the etiological standpoint, and hope 
the clinical differences were taken into consideration 
at the same time and as far as any division will per- 
mit. Thus we will have to distinguish Impotence 

i. From congenital malformations and defects of 
the sexual organs ; 

2. From acquired defects in the organs of genera- 
tion; 

3. Consecutive; 

4. Inherited; 

5. Neurasthenic; 

6. Professional; and 

7. Senile Impotence. 

1 Igiene deH'amore. Milano, 1881, p. 112. 



CHAPTER IV. 

FORMS OF IMPOTENCE. 

CONGENITAL MALFORMATIONS AND DEFECTS OF THE 
SEXUAL ORGANS. 

Congenital malformations of single organs of the 
human body are, fortunately, very scarce. While in 
the service of the Croatian government I was a 
member of the commission to examine the conscripts. 
Among six thousand young men there were only five 
who showed malformations of importance, and in 
three only were the genitals affected. 

As all these six thousand men were, without excep- 
tion, over twenty years of age, and as many indi- 
viduals afflicted with congenital deformities do not 
attain that age, it would not be safe to infer an 
infrequency of malformations; but we might rather 
conclude from it the relative percentage of malfor- 
mation of the genitals, because this does not shorten 
life so frequently as malformation of other vital 
organs. 

Hypospadia and excessive smallness are the most 
frequent of the malformations connected with the 
sexual parts; while entire absence of these organs is 
the most infrequent. 

In malformations which prevent copulation alto- 
gether, the outer attributes of virility are absent. 

96 



FORMS OF IMPOTENCE 97 

The whole appearance of these unfortunate beings re- 
sembles that of a woman, and appearance, voice, and 
behavior indicate that the formation of the genitals 
is not normal. 

In the exceedingly rare cases of absence of the 
penis there could be no possibility of copulation. 
Dr. Robert T. Harris 1 found in the literature six au- 
thentic cases of congenital absence of the penis, the 
urethra making its exit into or below the rectum. 
He estimates that one male in about thirty millions 
is born with this abnormality. In the fifty years up 
to 1898, England, France, Germany and Austria 
have reported one case each, the United States two. 
Entire absence of both testicles is quite as rare, and 
has, perhaps, never been observed in adults. 

Extreme smallness of the penis alone, or of the 
penis and testicles, occurs now and then, and is no- 
ticeable either at birth or later as an arrest of devel- 
opment. If the testicles are normally developed, 
and only the penis has remained very small, the de- 
sire and relative capacity for coition may be pre- 
served un weakened, but the result will be a failure. 

Such individuals are well aware of their defect, and 
are with difficulty induced to have intercourse with 
the opposite sex, particularly after they have had 
some bitter experiences. Most of them seek to satis- 
fy in some other way the sexual desire that they may 
feel. Some of these wretched beings are fortunate 
enough to meet a woman indifferent in sexualibus 
or one endowed with the ability to suppress her 

1 Medical Record, Feb. 19, 1898. 

7 



98 SEXUAL IMPOTENCE 

sexual passions sufficiently to enable her to live con- 
tentedly with a husband so deficient in the sexual 
organs. In justice to the fair ones we must ac- 
knowledge that the capacity of self-denial is a 
peculiarity inborn with the entire sex. If both penis 
and testicles are diminutive, there is a poor prospect 
for the sexual desire, such subjects, as a rule, never 
holding intercourse with the other sex. 

The opposite deformity — viz., excessive develop- 
ment of the penis — occurs also, and is usually in- 
dicative of great sexual power. It offers no obstacle 
to coition, provided a proper mate is found, and gen- 
erally, little difficulty is experienced in this line. 

It is very rare to find a marked congenital flexion 
in the penis arising from a deformity in the corpora 
cavernosa. Curvature to a very considerable de- 
gree would render copulation impossible. 

Of more frequent occurrence is a defective devel- 
opment of the erectile tissue, in which case the penis 
may be sufficiently large, but abnormally flabby. 
This congenital defect is, in my eyes, of great conse- 
quence, and I cannot understand how it is that, in 
spite of its frequency, it is ignored entirely by mod- 
ern authors. Lallemand alone has carefully de- 
scribed this condition. 

Impotence is said sometimes to depend also on 
great narrowness of the orificium externum ure- 
thras. 1 The possibility of this may be admitted the 

1 Maximilian v. Zeissl, Ueber die Impotenz des Mannes und 
ihre Behandlung. Wiener medicinische Blatter. Wien, 1885, 

Nr. 15. 



FORMS OF IMPOTENCE 99 

more readily since we know that stricture of the ure- 
thra undoubtedly causes impotence. I have had 
occasion to observe a man fifty-five years old whose 
orificium externum was exceedingly narrow, and who, 
though virile, could never impregnate a woman. It 
is more than probable that this malformation, unim- 
portant as it may seem, was the cause of the steril- 
ity; for the semen was quite normal, and an exam- 
ination of his wife brought no explanation to light. 

Some consideration is also due to the state of the 
prepuce and the frenulum. Complete absence of 
prepuce probably occurs very seldom. Even among 
the Orientals and Hebrews, who have continued to 
remove it for thousands of years, this artificially 
caused absence has never as yet become hereditary. 
Even if the absence of the prepuce were an effect of 
inheritance, it could not be prejudicial to the capac- 
ity for coition. Roubaud 1 asserts that the glans 
grows less sensitive, the act less agreeable, and con- 
sequently the carnal appetite less keen. Facts 
observed among our Hebrew fellow-citizens 
and in the Orient speak decidedly against this 
assumption. 

More frequently occurs a superfluity of prepuce, 
causing phimosis. Even phimosis in the highest 
degree cannot have a damaging effect on the capac- 
ity for copulation; it can only interfere with the 
natural course, and make surgical help desirable. I 
must, however, call special attention to the fact that 
congenital excessive length of the prepuce is gener- 

1 Traite de l'impiiissance et de la sterilite. Paris, 1876, p. 
100. 



IOO SEXUAL IMPOTENCE 

ally accompanied by a defective development of the 
member itself, so that, in some measure, the prepuce 
is only too long for the abnormally small penis, and 
then we have to deal only with the diminutive size of 
the penis. There is no doubt that the natural 
growth and development of the erectile tissue is im- 
paired by a prepuce that exerts any kind of an undue 
pressure upon the organ. Too small an aperture 
through the prepuce often causes sundry diseases, 
especially of a neurasthenic character. In recent 
times, observations of this nature grow in number, 
and surgical interference is quite frequently resorted 
to with excellent results. 

In cases of congenital phimosis it happens now and 
then that the prepuce adheres to the glans even after 
puberty has been reached, and this would be a posi- 
tive hindrance to coition. 

In California I had an opportunity to observe a 
case of firmly adherent prepuce occasioned by a sur- 
gical operation for phimosis, when not enough of the 
prepuce had been removed, and, besides, the margin 
of the wound had not been stitched. 

The frenulum is sometimes too long, sometimes too 
short. In the latter case it is a hindrance to erec- 
tion. I have been compelled more than once to sever 
a frenulum that was too short. In one case the glans 
was drawn downward, and in another the frenulum 
tore repeatedly during coitus, causing great pain. 

Not infrequently there is a natural inclination 
toward fissures on the surface of the glans and the in- 
side of the prepuce, whereby a temporary difficulty 
in copulation may be occasioned. I have seen a 



FORMS OF IMPOTENCE IOI 

young university professor who, after every excess in 
venery, were it ever so slight, suffered from deep and 
gaping fissures on the surface of the glans. 

Hypospadia of a high degree — i.e., congenital 
opening of the inferior wall of the urethra — and the 
much rarer epispadia — i.e., congenital opening of 
the upper wall of the urethra — may cause partial or 
absolute impotence. Hypospadia of the lowest de- 
gree — viz., when the orifice of the urethra is situated 
in the furrow of the glans, at the root of the frenulum 
— never interferes with copulation, but diminishes 
the chances of fecundation. In cases of hypospadia 
of a high degree, when the urethra opens as far back 
as at the perineum, and the member itself is very 
small, flattened, and bent downward, both copula- 
tion and fecundation suffer, as a matter of course. 

Quite similar are the cases of epispadia. Accord- 
ing to the degree of deformity, the member is at the 
same time shortened, flattened, and turned upward 
like a hook, so that introduction into the vagina suc- 
ceeds only partially or not at all, and the injection of 
semen is accomplished with great difficulty. Excep- 
tionally, impregnation may result in cases of either 
infirmity, even when of a high degree. 1 

Sundry circumstances may disturb the process of 
''descensus testiculorum," so that either one testicle 
remains in the abdominal cavity or else both. The 
former case is called monorchidia, and occurs oftener 
than the latter, which is called cryptorchidia. 
Neither of these conditions causes impotence if it is 
not accompanied by defective growth of the testi- 

1 Hofmann, Lehrbuch der gerichtlichen Medicin, p. 68. 



102 SEXUAL IMPOTENCE 

cles. It is even asserted that such hidden testicles 
produce more sperm because they are in a warmer 
location. 1 Cryptorchidia is said to cause sterility, 
but not impotence. 

These two assertions are contradictory. Godard, 
Hunter, and Curling have in cases of cryptorchidia 
found no spermatozoa in either testicles or vasa def- 
erentia, nor in the vesiculae seminales. Contrary to 
this, Taylor 2 knows four cases of cryptorchidia where 
there are children; Pelikan, one case; and Beigel 3 
found sperma in the semen of one affected with crypt- 
orchidia. 

It is beyond doubt that monorchidia cannot be 
injurious to potentia coeundi or generandi, because 
it seems, indeed, to be hereditary. I myself knew a 
civil official in Europe, a monorchis with large penis, 
who was very vigorous in sexualibus until an ad- 
vanced age, and late in life begat two boys, the 
younger of whom is also a monorchis. Each son has 
likewise a very large penis, and resembles his father 
in sexual vigor. 

Young people afflicted with such defects usually 
become very unhappy the moment they are aware of 
their defect, because they believe they will have to 
renounce sexual enjoyment. In many places the 
popular belief accredits such monorchids with pos- 
sessing extraordinary power. 

As rare curiosa we have to call attention to so- 



1 D. Campbell Black, Human Anatomy and Physiology, Part 
VII, p. 6. 

2 Hofmann, op. cit., pp. 59, 60. 

3 Virchow's Archiv, Bd. cviii, p. 144. 



FORMS OF IMPOTENCE IO3 

called hermaphrodites, individuals who, by vicious 
conformation of the genitals, or, as Lydston 1 terms 
it, "aberrant and imperfect differentiation of sex," 
are hindered partially or entirely from indulging in 
intercourse; also the much rarer cases of partial or 
entire want of single parts of the apparatus serving 
as excretory ducts for the semen, such as the vasa 
deferentia, ductus ejaculatorii, and vesiculas semi- 
nales. The rarest cause of impotence may be con- 
genital azoospermia. The very infrequent ectopia 
vesicas urinarias, which may sometimes be mistaken 
for hermaphroditism, is of no practical importance 
for us. According to Vigne 2 the individuals thus 
afflicted very seldom attain the age of 17 years. 
Recently better results are obtained by improved 
methods of surgical interference. 

ACQUIRED DEFECTS IN THE SEXUAL ORGANS. 

We mean by this the permanent defects. The va- 
rious diseases of the sexual organs will be treated 
later on. 

The entire or partial loss of penis or testicles will 
be the first subject of discussion. In the Orient 
there are even nowadays people on whom, during in- 
fancy, a most atrocious act has been perpetrated — 
that of cutting away the entire external apparatus 
of generation. Such perfect eunuchs bring higher 
prices than those who are deprived only of their 

1 The Surgical Diseases of the Genito-urinary Tract. Re- 
vised ed. Phila., 1906, p. 515. 

2 Torday. Missbildungea. Wiener Klinik, Heft 1, 1901. 



104 SEXUAL IMPOTENCE 

testicles. In Russia we have the Skoptzi, who, in 
insane fanaticism, voluntarily submit to such a 
mutilation. 

Of course, copulation is out of the question in a 
case of complete absence of the external genitals ; it is 
likewise impossible in the absence of the penis. Neg- 
lected venereal diseases sometimes destroy a part of 
the virile member, and malignant neoplasms some- 
times make its removal a necessity. There are, be- 
sides, unfortunate accidents and traumatic influ- 
ences that may cause loss of the penis. This is 
really a very pitiable condition, because the sexual 
appetite is left, while the possibility of satisfying it is 
gone. If, however, the traumatic action has left 
part of the penis, there is no impotence as long as the 
stump remains erectile. I knew a wealthy trades- 
man who had lost nearly the whole of the glans in 
consequence of a simple ulcerous disease which he 
had unwisely kept secret and neglected. After the 
wound was healed he had regular intercourse with his 
wife, but always took a long time to accomplish ejac- 
ulation. His wife complained that the friction of 
the skin and the cicatricial tissue caused her pain, 
wherefore she had always to apply a sufficient quan- 
tity of grease before copulation. The cicatricial tis- 
sue was not firm; in the flaccid condition of the penis 
it was very yielding. I never saw the stump during 
erection. 

The absence of testicles may be due to various 
causes. First of all, they may have been removed 
surgically — an unjustifiable operation, still prac- 
tised in the Orient, and formerly in Rome performed 



FORMS OF IMPOTENCE 105 

"ad majorem dei gloriam;" 1 they may have re- 
quired removal on account of disease or the growth 
of some tumor; or, finally they may have become 
completely atrophied from some cause or other, as, 
for instance, through syphilis, epididymitis, or pres- 
sure by a large hydrocele, varicocele, scrotal hernia, 
etc. 

Some authors are of the opinion that, " there is a 
secretion from the testicles that is necessary for the 
normal development and the health of the male " .... 
and "there seem to be two parts to the testicles, 
the seminal gland and an interstitial part. If the 
interstitial part does not develop in boys, a natural 
eunuch is the consequence. Variations in the 
internal secretions of the testicles may be from nor- 
mal to total absence, and all grades of developmental 
peculiarities be the result." 

As Osborne 2 further emphasizes there is an inter- 
dependence of the internal secretion of the testicles 
and the thyroid gland. "If there is thyroid in- 
sufficiency, the testicles do not develop properly, 
and if the testicles are removed the thyroid remains 
small." 

Nagel, 3 however, thinks that our reasons for an 
assumption of any function of the testicles other than 
the preparing of the semen are rather insufficient. 

1 Mantegazza, Gli amori degli nomini, vol. i, p. 175, says, 
" Man castrated himself and emasculated others, driven to this 
infamous mutilation by the most opposite reasons — the 
desire to triumph over human weakness and aspire to heaven, 
revenge, jealousy, luxury." 

2 Internal Secretions. Jour. Am. Med. A., Febr. 26, 19 10. 
8 Op. cit., p. 41. 



106 SEXUAL IMPOTENCE 

Zoth and also Pregel 1 seem to have obtained 
exact objective proof, by means of ergographic 
records, of the stimulating action of the testicular 
extracts upon the neuromuscular apparatus in man. 
They find that injections of testicular extracts cause 
not only a diminution in the muscular and nervous 
fatigue resulting from muscular work, but also 
lessen the subjective fatigue sensations. The 
natural direction in which we would look for evi- 
dence of the existence of an internal secretion on 
the part of the testes would be in their influence 
upon the sexual characteristics and sexual appetite. 
Most of the recent work has indicated quite clearly 
that the reproductive glands control the develop- 
ment of the sexual characteristics, not by way 
of a reflex nervous effect but by way of the blood; 
that is to say, through an internal secretion. The 
work, however, tends to show that the internal 
secretion is formed not by the reproductive ele- 
ments proper, the spermatozoa or the spermato- 
gonia, but rather by the so-called interstitial cells 
of Leydig, which lie outside of the seminal tubules. 
When a young animal is castrated completely the 
secondary sexual characters and the sexual appetite 
do not develop. If, however, the vas deferens is 
ligated, the sexual elements may disappear while 
the interstitial cells remain and increase in num- 
ber. In such animals the sexual instincts and 
characteristics develop normally. The clearest 
proof of the importance of the interstitial cells in 
this regard is furnished by the experiments of 
Steinach. Making use of very young animals this 

1 Howell, Op. cit. 



FORMS OF IMPOTENCE IO7 

observer has transplanted the testes from their 
normal position to other regions. Such animals 
develop normally, show all of the usual secondary 
sexual characteristics, and manifest full sexual 
desire and potency at the proper period. When the 
transplanted glands are examined it is found that 
the sexual elements are lacking, but the interstitial 
cells are increased in amount. It would appear 
from this work that the sexual puberty is dependent 
upon the internal secretion furnished by these cells, 
and Steinach proposes to designate them collec- 
tively as "puberty gland." This observer reports 
further remarkable experiments in which young 
males (rats, guinea-pigs) were first castrated, and 
then had transplanted under the skin or in the 
peritoneal cavity the ovary from the female of the 
same species. Under such conditions the graft 
of the ovary takes, and, unlike the grafted testicle, 
both the reproductive cells and the interstitial cells 
survive. In such animals the secondary male 
characteristics do not develop, his genital organs 
remain infantile; he exhibits, on the contrary, the 
female characteristics, as shown by his size, the 
character of the hair, and especially by the develop- 
ment of mammae and nipples. So far as the ex- 
ternal characteristics are concerned, the animal is 
sought by the male as though it were a true female. 
It would follow from these experiments that the 
internal secretion of the interstitial cells in the 
ovary and in the testis has each its specific in- 
fluence in guiding the development of the sexual 
characteristics. Many experiments and observa- 
tions indicate that the internal secretion of the 



108 SEXUAL IMPOTENCE 

ovaries are important, not only as regards so-called 
secondary sexual characteristics, but also in regards 
to the body-metabolisms in general. 

If the testicles are lost before puberty, both sexual 
desire and capacity for sexual gratification are im- 
possible; whilst both may be preserved for some 
time, possibly for a long time, if the testicles are lost 
after puberty. Such cases as are recorded where 
women have amused themselves with castrated 
men 1 refer to individuals who had been emasculated 
only a short time, or, at least, after puberty. 

At the University of Vienna, a fellow- student of 
mine had an obstinate epididymitis caused by gonor- 
rhea that brought on conditions in consequence of 
which one of the testicles had to be removed, where- 
upon the other testicle atrophied. This unfortunate 
young man practised copulation for some years after 
this, boasted of it, and quite ostentatiously courted 
the ladies. Gradually his power of copulating van- 
ished, and after three years he withdrew from the 
society of women altogether, grew peevish and 
reserved, until one day he disappeared and was never 
after heard of. This case has left a vivid impression 
on my memory, and illustrates quite characteristic- 
ally the influence of the virile power on the whole 
being. 

Epididymitis and infectious or other inflamma- 
tions of the vas deferens may cause permanent 
changes in the structure of these organs. Some- 
times complete obliteration of parts of the vas 

1 "Sunt quas eunuchi imbelles ac mollia semper 
Oscula delectent et desperatio barbae 
Et quod abortivo non est opus." — Juvenal. 



FORMS OF IMPOTENCE IO9 

deferens may result, and thus the communication 
between testicle and seminal vesicles may be inter- 
rupted. If such changes take place bilaterally, the 
effect will come near to that of castration. Inflam- 
matory processes in the region of the colliculus sem- 
inalis, mainly of a gonorrheal character, may result 
in a complete occlusion of the ejaculatory ducts, 
with consequent azoospermism. 

Somewhat in contradiction with these conclusions 
are the results of some experiments on dogs by M. 
Fabrini 1 which would show that a complete inter- 
ruption of the spermatic ducts would only cause a 
partial and momentary influence upon the functions 
of the testicles. 

It is true, as Chetwood 2 states, that many of the 
cases having had double inflammatory epididymitis 
still continue to suffer from a recurrence of inflamma- 
tory attacks in the epididymis, and some of these 
continue to have vital spermatozoa in their seminal 
discharges, and consequently retain the capacity to 
impregnate their wives; but this is only possible 
where the occlusion is not complete. I had occa- 
sion to observe a characteristic case of bilateral 
occlusion. 

A merchant 31 years old, somewhat obese, other- 
wise healthy in every respect, had several times 
gonorrhea and several attacks of epididymitis, some- 
what hazy about dates and details. Having been a 
jolly good fellow since the age of 16, he paid little at- 
tention to "such trifles." At the age of 26 he began 

1 Semaine medicale, Paris, Jan. 22, 1902, p. 31. 

2 Recurrent Epididymitis, Journal of Cutaneous and Genito- 
urinary Diseases, Oct., 1900, p. 450. 



IIO SEXUAL IMPOTENCE 

to notice a diminution of what he termed "the ani- 
mal passion;" also that ejaculation required a con- 
stantly increasing effort. During the past three 
years he had been treated by various specialists, phy- 
sicians, and quacks, his urethra has been dilated to 
French No. 33, irrigated, and irritated. At various 
times he took internally different doses of strychnin, 
iron, quinin, phosphor, damiana, cantharids and 
other more or less stimulating and tonic remedies. 
All kinds of organic extracts, from Brown-Sequard's 
fluid down to Hammond's famous Meduline, were 
given to him by mouth and subcutaneously ; he was 
suspended, his prostata and his testicles were mas- 
saged, all variations of the electric current passed 
through his spine and the nerves and their centra in 
and around the sexual organs. All in vain, his sexual 
desire began to be but a recollection, and the ejac- 
ulations always happened at longer intervals, re- 
quiring always greater efforts. 

The patient consulted me in February, 1896. The 
inspection showed a peculiarly wrinkled appearance 
of the glans, and both testicles, while of normal size, 
were of a more fibrous consistence, and of an almost 
homogeneous shape, the epididymis hardly being dis- 
cernible from the testicle proper. Repeated micro- 
scopical examination of the ejaculated fluid failed to 
show any spermatozoids. 

The patient was told his condition was incurable 
and that it could not be expected that the sexual 
libido and strength would ever improve, on the con- 
trary were bound to diminish constantly. The un- 
fortunate young man desired to know if he could 
marry. The answer was that this could be done honor- 



FORMS OF IMPOTENCE III 

ably only in case the lady in question were previ- 
ously informed of the existing condition. This he 
declared to be out of question. 

This patient is now married over thirteen years, a 
model husband, he and his wife to all appearance 
being happy. From time to time he inquires if any 
new discovery had been made to cure his disease. 
The erections continue to be fairly good, and he 
ejaculates about once in two months. The young 
wife is said to be glad that her husband is so clever 
in avoiding the troubles of paternity. 

I examined the patient recently, found his prostate 
gland considerably enlarged, but of normal con- 
sistency and sensibility. One would really be 
tempted to assume that the prostate in some cases 
vicariates for the testicles. 

Edward Martin 1 advises an operation for the re- 
lief of azoospermia, incident to bilateral obliterating 
epididymitis. He experimented at first upon dogs. 
The duct was divided and its upper end attached to 
an opening made in the head of the epididymis. 
The emissions of these dogs, which occurred days or 
weeks afterward, were swarming with motile sper- 
matozoa. A man who suffered from azoospermia, 
as the result of a double gonorrheal epididymitis 
was operated upon next. The duct was split, and 
one side of this opening sutured to the borders of the 
wound made in the head of the epididymis. The 
second emission following this operation two weeks 
later was found to be full of motile spermatozoa. 
The operation is tedious but not dangerous, and 

1 Jour, of Cutan. and Gen. Ur. Dis., April, 1902, p. 178. 



112 SEXUAL. IMPOTENCE 

ought to be tried in every suitable case as the only 
treatment that could do any good. 

Absence of one testicle, from whatsoever cause, 
leaves virility unaffected if the other testicle con- 
tinues its functions. The Hottentots are said to am- 
putate the left testicle of their youths before entrance 
into matrimony. 1 

Hydrocele of any origin, the syphilitic and tuber- 
cular included, seems to have no influence upon the 
sexual power. A hydrocele and inguinal hernia, if 
of a high degree, may encroach upon the integument 
of the penis, causing that organ to disappear from view 
completely, thus producing a mechanical impedi- 
ment to copulation. Tumors, by reason of their 
size, form, and position, may unfit the member for 
introduction into the female genitals. 

Injurious influences of a traumatic nature, more 
rarely diseases — as, for instance, those following 
gonorrhea — may produce changes in the corpora 
cavernosa, such as local obliteration of the meshy 
passages, nodi, and wheals or callosities. Under 
such circumstances the meshes will not all fill equally 
in erection, some parts remaining quite soft, whereby 
the member takes on a more or less bent form, 
and will thus become unable to penetrate into 
the vagina. Curschmann 2 mentions a pertinent 
and interesting case, not isolated in literature : A ro- 
bust railway official, twenty-six years old, awakened 
one morning with a violent erection. He endeav- 

1 Mantegazza, Gli amori degli nomini, vol. i, p. 175. 

2 Impotenz, Band ix. 2 ; Ziemssen, Handbuch der speciellen 
Pathologie und Therapie, p. 530. 



FORMS OF IMPOTENCE 113 

ored to bend the penis downward, when suddenly it 
gave way, caused great pain, and sank down. There 
was profuse bleeding underneath the skin of the 
penis, so that it was black and blue and almost as 
large as a fist when Curschmann saw the patient. 
After recovery it was discovered that by the violence 
practised the right corpus cavernosum had been torn, 
and, in consequence, at every erection the penis was 
bent upward and to the right, so that copulation be- 
came mechanically impossible. 

Small fissures in the corpora cavernosa may be 
caused by violent motion during coitus. Such a case 
I had under my care in the year 1887. A restaurant- 
keeper, forty-one years of age, wanted, after a slight 
excess in Baccho, to do homage to Venus also. Both 
he and his wife were in a somewhat exultant mood, 
and probably proceeded rather impetuously. The 
husband told me that the erection was of unusual 
vigor, and just before ejaculation he suddenly felt a 
sharp pain, so that he had to discontinue the act. 
The erection subsided at once, but the appearance of 
the member was such that he was compelled to get 
medical advice. When I saw the man, an hour after 
the occurrence, the penis was much swollen, black 
and blue all over, only an irregular streak on the 
right-hand side having its usual color. I ordered 
cold applications and occasional painting with iodin. 
After ten days the swelling had disappeared. I 
could feel a somewhat hardened spot on the left cor- 
pus cavernosum, but there was no further interfer- 
ence with erection and copulation. Heinrich Ganz 1 

x Prager med. Wochenschrift, 1896, No. 26. 
8 



114 SEXUAL IMPOTENCE 

reports a case of rupture of the urethra under similar 
circumstances. 

Finally, there are to be mentioned the so-called 
penis-bones. They are of very rare occurrence, and 
may arise through the ossification of single parts of 
the albuginea of the corpora cavernosa. In case 
they seize upon larger parts, they may prevent dila- 
tation, and thus annihilate erection and the power of 
copulation. 

Persistent changes in the mucous membrane of the 
urethra, such as strictures, frequently, but not al- 
ways, cause impotence. 

CONSECUTIVE IMPOTENCE. 

The performance of coition requires all the power 
of the individual and, above all, a normal state of the 
whole body. The most various diseases can affect 
sexual vigor and even destroy it. 

Of least account is virility in acute diseases of a 
serious nature. Sexual desire is heightened during 
the prodromal stage of most of the acute diseases as 
long as the approaching fever, which may be quite 
high, is only announcing itself by an incomprehensi- 
ble agitation and general uneasiness. Such patients 
are sometimes carried along violently to sexual ex- 
cesses. I have often watched this condition Thus, 
for instance, a man, twenty-six years of age, accom- 
plished coition, contrary to his usual habit, three 
times in the night before scarlet fever declared itself, 
as he ascribed heaviness in his legs and a state of ex- 
citement to unsatisfied sexual desire. 



FORMS OF IMPOTENCE 115 

During the illness, on the contrary, the sexual ap- 
petite is nil. During convalescence every other de- 
sire will make its appearance before this one, and its 
reawakening is rightly greeted as the sign of re- 
turning strength. The patient requires his forces for 
other purposes during attacks of acute diseases, and 
his temporary stagnation in sexual activity is a wise 
provision of nature ; it would be absolutely wonder- 
ful if, unfortunately, other functions of the body, and 
principally that of digestion, were not impaired at 
the same time. 

After a protracted, severe, and exhausting illness, 
during which the reproduction of spermatozoids 
diminishes or may be altogether arrested, 1 impotence 
sometimes lasts a long time. All the other conse- 
quences of the illness may be overcome before this 
sexual weakness, so that there may be a danger of its 
becoming permanent. Diphtheritis, which is some- 
times followed by protracted paralysis and muscular 
atrophy, causes impotence now and then. 2 

The assertion is met with in old books, and has 
been copied into modern ones, that persons affected 
with phthisis are generally apt to commit sexual 
excesses (phthisicus salax). I most emphatically 
deny this. A phthisic person may have acquired the 
habit of frequent sexual intercourse in former times, 
and then, during his illness also, may go to excess for 
a time ; but, surely, these are exceptions. As a rule, 

1 Rosenthal, Ueber den Einfiuss von Nervenkrankheiten auf 
Zeugung und Sterilitat. Wiener Klinik, 1880, Heft 5, p. 165. 

2 Hofmann, Lehrbuch der gerichtlichen Medicin. Wien und 
Leipzig, 188 1, p. 66. 



Il6 SEXUAL IMPOTENCE 

phthisics are not much inclined to physical love nor 
to any kind of sexual gratification, and this is in 
keeping with the condition of their physical strength. 
For the purpose of noting this feature I have for 
many years past carefully watched and examined 
numerous phthisical patients. Without exception 
and without regard to age, they all entirely re- 
nounce sexual gratifications without experiencing 
the least difficulty. Indeed, quite young husbands 
affected with phthisis practise copulation very infre- 
quently even during the intermissions of their illness. 

My distinguished colleague, Albert Abrams, as- 
sured me recently that his large experience bears 
out my opinion. 

The majority of the men experienced in the treat- 
ment of tuberculosis, whom Peters 1 interviewed in 
this regard, were of the opinion that increased sexual 
desire is not a condition due to the toxins generated 
in the tuberculous ; that such a desire (when present) 
is due chiefly to idleness. 

Finger 2 considers tuberculosis to have been directly 
the cause of sexual impotence in several cases he 
observed. 

Chronic diseases impair the sexual power pro- 
portionately to their effect on the rest of the body. 
Chronic diseases in the organs of respiration and of 
digestion affect virility only in the same measure as 
they debilitate the body in general and lower vital- 
ity. Autointoxication caused by various products of 
an undue fermentation in the intestines is a very 

1 Jour. Am. Med. A., Jan. 30, 1909, p. 416. 

2 Handbuch d. Urologie, Wien, 1906, i7te Abth., p. 961. 



FORMS OF IMPOTENCE II 7 

common cause of temporary weakening of the sexual 
power. 

Autointoxication is a question of the utmost im- 
portance, physicians begin to understand it always 
more and more, a great deal of investigating is going 
on, and finally the subject is receiving the attention 
it certainly deserves. 

We know that autointoxication causes depressed 
feeling and lowers the energy of the entire metabol- 
ism ; it were surprising then if it did not dull the sex- 
ual desire, feelings, and strength. Swinburne 1 calls 
attention to oxaluria as a cause of prostatic or 
urethal disturbances and sexual weakness. My 
personal experience confirms his observations. It 
is absolutely necessary to make a careful microscopic 
examination of the urinary sediment in every one of 
the chronic troubles in the genito-urinary system. 

Disease of the heart does not impair virility until it 
amounts to a serious disturbance of the circulation. 
In the first stage of the disease the patient is rather 
nervous and inclined to sexual excess. The same 
is true with those suffering from disease of the liver. 

Virility is affected also by some general diseases. 
Impotence is particularly frequent, in fact a rule, with 
persons suffering from diabetes, and often constitutes 
one of the first symptoms of the disease, noticed long 
before the physical being commences to deteriorate. 
The seminal secretion is also said to stop in this dis- 
ease, but I have repeatedly observed cases, where 

1 Oxaluria as a cause of prostatic and urethral disturbance. 
The Am. Jour, of Urology, Oct., 1906, p. 534-540, and The 
Annals of Surg., Sept., 1908. 



Il8 SEXUAL IMPOTENCE 

ejaculation of normal semen occurred frequently, 
though erections were poor. 

As a special enemy of the virile power must be 
mentioned obesity. In exceptional cases obese 
people may be very powerful in sexualibus. I my- 
self have known such cases, but obese persons are 
usually fond of their comfort, in copulation as in 
everything else. They frequently prefer the pleas- 
ures of the table to those of love, and moreover, are 
not much troubled by sexual desire. They give off 
but a scanty secretion of sperm, often suffer from 
adipose degeneration of the testicles, and are apt to 
become completely impotent. Kisch found invaria- 
bly that the sperm of nine out of ten obese men 
showed under the microscope only molecular detritus 
and sperm-crystals, but no spermatozoa at all. The 
deleterious influence of obesity upon the sexual 
strength is easier to understand at present when we 
know that "diminished activity of the pituitary 
gland conduces to obesity and sexual infantilism." 
In case of obesity of a high degree, especially when 
there is a pendulous abdomen, copulation may be 
mechanically impossible. 

Belfield describes a form of impotence which may 
be due to a deficient secretion by the adrenal cortex. 
In the case he describes the retrograde puberty, 
impotence, diabetes insipidus were promptly relieved 
by the administration of suprarenal substance. 

The various forms of nephritic affections certainly 
influence the sexual power out of proportion to the 
debilitating effect they have upon the balance of the 
system. 



FORMS OF IMPOTENCE 119 

Anemia may be a cause of impotence, like any 
other disease carrying in its train debilitation of the 
body in general. If anemia is acute, it is generally 
accompanied by impotence, while anemia of a 
chronic nature causes at first only weakening of the 
sexual capacity. According to Roubaud, 1 chlorosis 
is also a cause of impotence, but the case he describes 
is such that I should certainly characterize it as 
neurasthenic. 

During the last few years we have learned a 
great deal in regard to the clinical importance of 
blood-pressure in various bodily conditions. I have 
made it a practice to take the blood-pressure in 
every case of sexual debility. While my findings 
are far from being conclusive, I observed that high 
blood-pressure most frequently goes with sexual 
impotence, and that sexual excesses have the 
tendency to lower the blood-pressure. 

It would seem almost incredible that a severe cold 
could affect virility seriously, though temporarily 
only, if we do not take into consideration the fact 
that the sense of smell influences the sexual appetite. 
In a man really vigorous sexually a cold, be it ever so 
severe, cannot annihilate virility, though it lessens 
the sexual desire. Schiff has removed the nervi 
olfactorii in new-born dogs, after which the male was 
unable to find the female. Mantegazza deprived 
rabbits of both eyes without any effect on copula- 
tion. 2 In man the olfactory sense has not so great a 
power as in animals, because a great share of influ- 
ence over the center of erection has been allotted to 

1 Op. cit., p. 213. 

2 Igiene dell'amore. Milano, 1881, p. 277. 



120 SEXUAL IMPOTENCE 

other senses as well as to the developed faculty of 
thinking; nevertheless, the sense of smell is very- 
important. There is an intimate relation between 
engorgement of the turbinate tissues and the sexual 
apparatus. Albert Abrams 3 had an asthmatic pa- 
tient who could never indulge in coitus without 
suffering an asthmatic paroxysm. During the act, 
swelling of the nasal mucosa occluded his nose. 
Another of Abrams' patients would develop an attack 
of sneezing coincident with the attempt at intercourse. 

In both instances, the sexual act was consummated 
by the previous employment of cocain to the nasal 
mucosa. 

Impotence is very frequently a symptom of dis- 
ease of the central or peripheral nerve apparatus. 
This is clear to any one even without a thorough 
knowledge of physiology. The practitioner sees 
typical examples almost every day. Nearly all dis- 
eases of the brain and of the spinal cord have great 
influence over the virile power — some only for a 
time, others permanently, according to the character 
of the disease in question. Some of these diseases 
cause at first increased sexual excitement, which, in 
the further course of the disease, is followed by di- 
minished sexual power or absolute impotence. A 
given disease of the brain and spinal cord does not 
always have the same effect in this respect. Apo- 
plexy of the brain, for instance, may cause frequent 
erections at one time and entire loss of sexual desire 
and power at another, according to the location of 
the lesion. 

1 Diagnostic Therapeutics, Rebman Co., N. Y"., 19 10, p. 229. 



FORMS OF IMPOTENCE 121 

In the first stage of tabes dorsalis the patient expe- 
riences for the most part an increased sexual desire, 
in consequence of irritation of the nerve-fibers which 
innervate the sexual apparatus; but later on sexual 
vigor gradually diminishes until it is entirely extin- 
guished. Cases are known, nevertheless, where tabes 
existed in a high degree and yet the patient was still 
in some measure virile. 

From this little we may conclude that there are no 
absolute rules to be given about the state of virility 
in affections of the brain and spinal cord. The phy- 
sician has to examine every individual case and de- 
termine his treatment accordingly. Moreover, in 
these diseases the medical man must direct his atten- 
tion to other things ; he has no time to think of sexual 
virility, especially when life is in danger; and, be- 
sides, the patients — as the ataxic, for instance — care 
very little for the sexual power, for, as a rule, the 
desires are silent. 

Impotence seems to me still more insignificant in 
some forms of insanity, excepting those of perverse 
sexual sensation, of which we shall speak hereafter. 

Lesions of the brain or spinal cord may affect 
virility according to the spot injured. In the litera- 
ture of the subject we read of cases where injury of 
the cerebellum has brought about a loss of sexual 
power. In certain injuries of the spinal cord, prin- 
cipally those of the inferior parts, and especially in 
spinal concussion, priapismus has been noticed. It 
constitutes one of the most troublesome symptoms, 
and defies all remedies. Lallemand 1 reports a very 

1 Des pertes seminales, tome ii, ire partie, p. 64. 



122 SEXUAL IMPOTENCE 

characteristic case. Rosenthal 1 mentions a case he 
has observed in which there was a fracture of the 
fourth, fifth, and sixth cervical vertebrae, with paral- 
ysis and anesthesia of the legs and trunk, together 
with retention of the urine and feces, and pria- 
pism for seven days during life and thirty-six hours 
after death. 

Those cases in which impotence is to be considered 
as a symptom of some disease of the entire nervous 
apparatus have more importance for us, because they 
occur more frequently, are of more consequence to 
the patient, and, finally, because therapeutic action 
is attended with more chance of successful result. In 
these cases no change in the nerve substance can be 
seen either macroscopically or microscopically. The 
pathological change consists simply in the altered 
capacity of nerve-action. 

In the first place must be mentioned general ner- 
vousness, or, to call it by the name that originated in 
America, neurasthenia, or, as Rosenthal 2 calls it, 
depressive spinal irritation, all of which names are 
entirely appropriate. Neurasthenia has grown into 
a fashionable disease in this age of electricity, when 
every one belonging to the upper class has to hurry 
from early morning till late at night in order to ac- 
complish his measure of work or of pleasure; when 
the everlasting hurrying begins in infancy and still 
continues during old age. By these psychical exci- 
tations, which . exert such a frequent and lasting 
effect, the center of the vaso-constrictors particu- 

1 Ueber den Einfluss von Nervenkrankheiten auf Zeugung und 
Sterilitat. Wiener klinik, 1880, Heft 5, p. 145. 
* Op. cit., p. 142. 



FORMS OF IMPOTENCE 1 23 

larly is kept in a state of irritation. Beard described 
the conditions very forcibly when he said 1 : 

"The Indian squaw, sitting in front of her wig- 
wam, keeps almost all of her force in reserve. The 
slow and easy drudgery of savage domestic life in the 
open air — unblessed and uncursed by the exhausting 
sentiment of love, without reading or writing or cal- 
culating, without past or future, and only a dull 
present — never calls for the full quota of her available 
force: the larger part is always resting on its arms. 
The sensitive white woman — preeminently the 
American woman, with small inherited endowment 
of force, living in-doors, torn and crossed by happy 
or unhappy love, subsisting on fiction, journals, 
receptions, waylaid at all hours by the cruelest of 
robbers, worry and ambition, that seize the last unit 
of her force — can never hold a powerful reserve, but 
must live, and does live, in a physical sense, from 
hand to mouth, giving out quite as fast as she takes 
in, much faster oftentimes, and needing long periods 
of rest before and after any important campaign, and 
yet living as long as her Indian sister — much longer, 
it may be — and bearing age far better, and carrying 
the affections and the feelings of youth into the de- 
cline of life. " 

Neurasthenia is either congenital or acquired. 
According to the rules of heredity, neurasthenic par- 
ents have neurasthenic children, or, rather, they 
have children naturally inclined to neurasthenia, 
which will tend to develop in them more and more 

1 Beard-Rockwell, Sexual Neurasthenia, fifth edition. New York, 
1898, p. 59. 



124 SEXUAL IMPOTENCE 

under the least favorable circumstances, and who, if 
their regimen is not strictly regulated, will exceed 
their parents in neurasthenia. 

General nervousness with its manifold symptoms 
is by no means a rare disease. The symptoms are 
frequently held to be special diseases, and it is only 
an apparent extreme if Beard and his disciples trace 
most of the diseases back to neurasthenia. It is an 
established fact that this neurasthenia is of much 
more frequent occurrence in America than in Eu- 
rope. Explanation of this circumstance suggests 
itself when we compare the mode of living on the 
two sides of the Atlantic. 

Beard 1 gives the following definition of neuras- 
thenia: " Neurasthenia is a chronic, functional dis- 
ease of the nervous system, the basis of which is im- 
poverishment of nervous force, deficiency of reserve, 
with liability to quick exhaustion, and a necessity for 
frequent supplies of force; hence the lack of inhibi- 
tory or controlling powers, physical and mental — 
the feebleness and instability of nerve action and the 
excessive sensitiveness and irritability, local and 
general, and the vast variety of symptoms, direct 
and reflex. 

According to Arndt, 2 neurasthenia is increased or 
decreased excitability and irritability in conjunction 
with incapacity to resist external influence — i.e., 
weakness in general. 

The symptoms of neurasthenia are, according to 
Beard, the consequence of reflex irritations which 

1 Beard-Rockwell, op. cit., p. 36. 

2 Die Neurasthenie. Wien und Leipzig, 1885, p. 40. 



FORMS OF IMPOTENCE 1 25 

pass not merely through the ordinary sensory and 
motory nerves, but also through the sympathetic 
system and the vasomotor nerves. The reflex irrita- 
tion can start from any part of the body and pass over 
to another, but the brain and the digestive and re- 
productive systems are to be considered as the main 
seats. The symptoms of neurasthenia are incon- 
stant and surprisingly interchangeable. Erb distin- 
guishes between a "cerebral," a "spinal," and a 
"universal" neurasthenia; Beard was the first to 
recognize a "sexual" neurasthenia. 

According to Beard, the sexual nervous exhaustion 
may be considered as cause, effect, or accessory to 
the other kinds of neurasthenia, but must, neverthe- 
less, when fully developed, be distinguished from 
them just the same as general neurasthenia is to be 
distinguished from hysteria, hypochondria, and the 
various organic diseases of the nervous system with 
which it was confusingly mingled until quite recently. 
Beard considers sexual neurasthenia in general, and 
particularly in reference to its various complications, 
almost the most important of all the forms of neu- 
rasthenia. It must attract our notice that he fur- 
ther asserts that the clinically connected local condi- 
tions of sexual weakness in man, such as impotence, 
spermatorrhea, and the "irritable prostata," are to 
be looked upon merely as symptoms of sexual neu- 
rasthenia. This would, indeed, make matters easy, 
and the single word "neurasthenia" would explain 
many a thing that has appeared quite inexplicable 
until now. And here we come to the point where the 
modern urologist thoroughly disagrees with the 



126 SEXUAL IMPOTENCE 

neurologist; and with right. Today we are able to 
explain many a case of so-called neurasthenia by 
showing pathological changes in various parts of the 
sexual organs, be it now the ampullae, the seminal 
vesicles, the prostate, the ejaculatory ducts, or the 
region of the verumontanum and other parts of the 
urethra itself. 

The more our means of investigation are per- 
fected, the fewer cases of genuine sexual neurasthenia 
we meet. Goldschmidt's endoscope and Buerger's 
cysto-urethroscope by bringing the posterior urethra 
into real and splendid view show us many a change 
on and around the caput gallinaginis of which we 
could not have a proper idea before the advent of 
these instruments. 

And who can tell at present how many and what 
cases of neurasthenia are due to the impaired and 
faulty internal secretion of the prostatic gland? 

Thus we can at best, consider as symptoms of an 
existing sexual neurasthenia only those cases of impo- 
tence and spermatorrhea in which the organic condi- 
tions and their pathological alterations offer no hold 
at all for an explanation of the disease. 

B. Goldberg, 1 of Wildungen, however, distinguishes 
three groups of sexual neurasthenics. First, those 
who show considerable pathological changes in the 
genito-urinary organs. Second, those in whom the 
anatomical changes are quite insignificant; and 
third, a group comprising the pure functional dis- 
turbances. Experience teaches that important 
pathological changes may exist at the same time, or 

1 Therapie der Gegenwart, 1900, Heft 10, p. 460. 



FORMS OF IMPOTENCE 1 27 

cause sexual neurasthenia. If the functional dis- 
turbance does not improve with the gradual improve- 
ment of the organic disease, then we have two dis- 
tinct diseases with which to deal. We must be care- 
ful not to confound real sexual neurasthenia with 
temporary neurasthenic symptoms caused by sexual 
diseases. 

Beard states that the causes of sexual neurasthe- 
nia are: unfavorable social conditions, sexual ex- 
cesses, immoderate use of alcohol and tobacco, spe- 
cial irritants, grief, and even climate; but, above all, 
he believes that the most prominent and predisposing 
causal force is modern civilization in regard to its 
wants and claims that are increasing from day to day. 

While most authors claim that neurasthenia 
is rapidly spreading, Munsterberg 1 expresses his 
doubts by saying, "We may begin with the very 
justifiable doubt whether nervousness really has 
increased in our time. Earlier periods had not so 
many names for those symptoms and were not able 
to discriminate them with the same clearness. 
Above all, the milder forms of abnormalities were 
not looked upon as pathological disturbances. If 
a man has a pessimistic temperament idea, or 
imagines that he feels an illness which he does not 
have, or has no energy to work, even today most 
people are still without suspicion that a neuras- 
thenic or a psychasthenic or a hysteric disturbance 
of the nervous system may be in its beginning. 
Earlier times surely may have treated even the 
stronger varieties of this kind as troublesome 

1 Psychotherapy, New York, 19 12, p. 193. 



128 SEXUAL IMPOTENCE 

variations in the sphere of the normal. On the 
other hand, there can be no doubt that, for instance, 
the Middle Ages developed severe diseases of the 
nervous system in an almost epidemic way, which 
is nearly unknown in our time." 

C. W. Allen 1 while in tropical Mexico made very 
interesting observations in regard to climatic influ- 
ences upon certain individuals, particularly blonds, 
and supposes it is the absence of pigment in the skin 
which permits the over abundance of sunshine to 
cause neurasthenia and impotence. 

The attentive reader of the excellent work of Lalle- 
mand " On Spermatorrhea" will not fail to notice that 
it contains ideas approaching those of Beard, and I am 
inclined to agree with Lallemand rather than with 
Beard. Lallemand quotes observations where nearly 
incurable cases of spermatorrhea or impotence have 
followed insignificant causes — as, for instance, slight 
sexual excesses — which would have had in other 
individuals either no effect at all or, at least, an affect 
of no consequence. Lallemand explains this by 
assuming a natural nervous predisposition to what is 
now called neurasthenia. 

Beard asserts that neurasthenic individuals are 
able to accomplish fatiguing mental work for years, 
and often during the whole period of life; so that, 
sometimes, nervousness and neurasthenia are asso- 
ciated with an enormous capacity for mental exer- 
tion. To illustrate this assertion, Beard says that it 
was by neurasthenic authors that the epoch-making 
works were produced; and names like George Eliot, 

1 Impotency in the Male. N. Orleans Med. and Surg. Jour., 
May, 1908. 



FORMS OF IMPOTENCE 1 29 

Darwin, Heine, Spencer, Edwards, Kant, Bacon, 
Montaigne, Joubert, Rousseau, Schiller, and many 
more of the same rank illustrate beautifully the truth 
of the sentence that it is possible to produce works of 
genius and of consequence even with a limited quan- 
tity of nerve-substance and nerve-power, attended 
by a rapid consumption of the same. It seems to 
me fair, however, to question whether all the above- 
named celebrities were really neurasthenic, and also 
whether their neurasthenia was not more likely to 
have been caused by their colossal mental efforts than 
to have produced such works. 

Beard's method of reducing to neurasthenia nearly 
all the pathological states in the system of reproduc- 
tion would at once rid us of a great number of diffi- 
culties that assail every one who studies impotence. 
It would do away with the difficulty of arranging the 
different forms of impotency, according to some logi- 
cal system ; because we should have only to differen- 
tiate a neurasthenic from an organic impotence, and, 
moreover, the diagnosis would also be an easier task ; 
but, alas, the facts oppose such a simplification, and 
we have nothing to do but to continue the old patch- 
work now in use as well as we can. We can agree to 
the consideration of neurasthenic sexual weakness as 
a phase of a spinal or general neurasthenia, and must 
look upon an independent or self-subsisting neuras- 
thenia sexualis as a form of impotence occurring fre- 
quently enough. 

Very often virility is affected by diseases of the 
sexual organs ; this influence is in some cases a second- 
ary one. Thus, for instance, will local affections on 
9 



130 SEXUAL IMPOTENCE 

and about the colliculus seminalis, or pathological 
changes of the canals or apertures discharging into it 
cause, as a first effect, irregular involuntary losses, or 
premature ejaculation of semen, and in this 
manner, indirectly, slowly, but surely, exhaust the 
sexual power, and lead to various forms of sexual 
neurasthenia. 

Several diseases of the sexual organs have a direct 
influence on virility. Thus, wounds and ulcers of the 
penis are a direct obstacle to the accomplishment of 
coitus, whether they are of a specific nature or not. 
The same may be said of the condylomatous prolifer- 
ations of a high degree, because every erection, and 
still more, friction against the female pudendum, 
causes great pain. 

Some individuals suffer much from nearly contin- 
uous formations of herpes on the prepuce, the vesicles 
of which afterward turn into little sores. Uncleanli- 
ness is not always the cause of this disease ; it is some- 
times the consequence of an ulcus molle. Some peo- 
ple suffer from it without any apparent cause after 
every sexual connection, such vesicles forming on the 
member and preventing coition for a time. The 
very rare preputial calculus ("calculs du prepuce," 
Roubaud) may also form an obstacle to coition, but 
this is removable, and it certainly occurs only in con- 
sequence of great uncleanliness in connection with 
phimosis. Let me mention here that there are peo- 
ple who, seized by violent sexual desires, are capable 
of bearing even great pain; they feel no scruple in 
satisfying such imperious instincts, although thereby 
they harm themselves as well as others by increas- 



FORMS OF IMPOTENCE 131 

ing their own suffering and propagating infectious 
diseases. 

Gonorrhea also is in reality an obstacle to copula- 
tion ; but it is an obstacle about which people of the 
above description care very little. The disregard of 
this obstacle is of so much greater frequency as, un- 
fortunately, the sexual impulse is so much stronger 
during blennorrhea, particularly in its acute stage. 
This circumstance contributes greatly to the dissem- 
ination of the disease. In the chronic forms of gon- 
orrhea the state of irritability of the urethra, and 
therefore of the whole sexual apparatus, exists only 
slightly or not at all, but is sometimes roused to un- 
usually violent manifestations by the locally applied 
remedies, such as caustic injections, sounds, etc. 

Other obstacles set up by gonorrhea to the accom- 
plishment of copulation are the further complications 
and the higher degrees of development which the dis- 
ease often produces, and the extension of the blen- 
norrhea process, such as inflammation of the pros- 
tata, the vas deferens, the epididymis, and the ves- 
icula seminalis. Any one afflicted with such a dis- 
ease will, however, not readily yield to the tempta- 
tion of coition as long as the pathological process is 
in its acute stage. 

Virility is affected by the many diseases of the 
prostata. 

Until a few years ago the anatomy, physiology and 
pathology of the prostate were not considered of 
much importance. In 1888, when the first German 
edition of this work was published, it took quite a 
while to search for literature on the subject, and when 



132 SEXUAL IMPOTENCE 

all of any importance was collected, the reading did 
not take very long. I defy any one to attempt the 
gathering of all the scientific productions on the 
subject written since. 

The differences in the anatomical description of 
the prostatic gland which we find even in text- 
books can easily be explained by the almost regular 
individual differences, and by the almost incredibly 
frequent pathological changes. Our real difficulties 
begin when we enter upon the discussion of the 
functions of the prostate. 

Of course, the physiology of the prostatic gland is 
perfectly clear to various excellent physiologists and 
urologists, the trouble is only that there is such a 
diametrical divergence of opinions and even of 
results in the most essential experiments and deduc- 
tions, so that we must come to the conclusion that 
some of the things that seem to be so clear to several 
scientists are not correct. 

We must agree with Reynolds when he claims 
that we are unable to say definitely what the exact 
function of the prostate is, though it is now generally 
conceded that the physiological function of the 
prostate is almost exclusively a genital one. But 
even Nagel 1 when explaining the functions of the 
prostate in his handbook of physiology is rather 
guarded in his statements, just saying that the de- 
velopment of the prostate being characteristically 
different according to the different ages points dis- 
tinctly toward its relations to the sexual activity. 

We learn by our clinical experience that however 

1 Op. tit., p. 63. 



FORMS OF IMPOTENCE 133 

things may be, the prostate has an important part 
in the sexual life and also in the act of micturition. 
In the latter regard its office may be of no importance 
under normal circumstances but jumps into great 
prominence as soon as pathological changes have 
ta'ken place. 

In acute inflammations we are surely tempted to 
consider the prostate to be a urinary organ, and are 
not surprised that once the name of orbicularis vel 
sphincter urethras for both the prostate and the prolon- 
gation around the menbranous urethra was proposed. 

The part which the prostatic secretion has in re- 
gard to the semen is, in spite of numerous interesting 
and meritorious experiments, not quite clear, and it is 
rather significant that even the chemical reaction of 
this secretion, and its importance as to the vitaliza- 
tion of the spermatozoa is not an undisputed fact, 
although we know that necrospernia is a frequent 
consequence of prostatitis. 

Thus we may understand why the modern urolo- 
gists feel compelled to return again and again to the 
study of the prostatic gland. Physicians told me 
repeatedly that when referring a case to a urologist 
they are almost invariably told the patient has 
prostatitis. But we know that prostatitis is the 
most frequent complication of gonorrhea, that gonor- 
rhea is the most frequent disease, and that prostatitis 
is most difficult to cure and our fellow practitioners 
may easily understand and also forgive that the 
diagnosis of prostatitis is so frequently made. 

So long as the gonococcus has not invaded the 
prostate the gonorrhea is amenable to treatment, 



134 SEXUAL IMPOTENCE 

once in the prostate the way of invasion of important 
organs is open by the road of the bladder to the ure- 
ters and kidneys, by the road of the seminal duct, to 
the epididymis. Wolbarst emphasizes with right 
that the prostate must be examined in every case of 
gonorrhea before the patient is discharged and that 
the condition of the prostate must be ascertained 
from time to time in the course of the disease, and 
I am sorry that he does not tell us what he does to 
nip in the bud time and again "what might have 
insidiously become a chronic intractable gonorrhea." 
It was my experience that when the gonococcus once 
has invaded the prostatic gland, there is no more nip- 
ping in the bud to be done by the physician ; nature 
may accomplish it if there is no interference by the 
patient's misconduct or too strenuous a treatment. 
The symptoms are mostly clear in cases of typical 
acute prostatitis, and then a diagnosis is easily made; 
one can even go so far as to differentiate between a 
catarrhalic, a follicular and a parenchymatous form of 
inflammation, but as a rule the acute stage, the actual 
invasion of the prostate is not so typical, the symp- 
toms are very light, the patient hardly pays any 
attention to them, occasionally telling his physician 
of an increased frequency in urinating, and of a final 
disagreeable sensation at the end of each micturition ; 
the more or less developed symptoms of tenesmus. 
And thus it happens that the first invasion of the pros- 
tatic gland is almost regularly overlooked, and so 
much more regularly because cases of fresh gonorrhea 
that are properly treated, by carefully observing 
experts, seldom develop prostatitis. 



FORMS OF IMPOTENCE 135 

With the exception of the not very frequent cases 
of aseptic prostatitis, the consequence of habitually 
interrupted coitus or masturbation, prostatitis is 
always caused by propagation of an inflammation in 
the urethra. 

When we ask how does this involvement happen 
and what is the immediate agent causing it, how 
does this agent act and behave? we reach the biggest 
snag of the whole prostatic question. No doubt 
the gland is being invaded by a germ. In acute 
gonorrhea we have the wily gonococcus, and no mat- 
ter what Albaran may say, it must be the gonococcus 
that invades the prostatic gland. What happens 
to the microogranism once located in the gland is at 
present hard to say. Some think the gonococcus 
may persist for many years imbedded somewhere in 
the prostate, and others are of the opinion that the 
gonococcus makes room for other forms of bacteria. 

The question is not so simple as some of our fellow- 
workers think. The process cannot be tabulated so 
nicely as Notthaft has done, and I dare to say that 
the study of this phase of our subject is far from being 
clear. The task to investigate and to systematize 
the bacterial geneology of the prostate may seem 
very easy, is extremely attractive, but no doubt is 
worthy of a scientific Sisyphus. 

More cases one examines in every direction, more 
smears one inspects under the microscope, more cul- 
tures one makes, more perplexing problems one 
meets. Dr. Philip Rahtjen of San Francisco, the 
well known biologist, was very enthusiastic when I 
proposed to him that we should go to work and find 



136 SEXUAL IMPOTENCE 

out all there is to the living germs in the prostate. 
We were careful to obtain the real and pure prostatic 
secretion, and in every case several smears were 
microscopically examined, and at least two cultures 
were prepared on blood-serum, blood-agar, agar- 
glycerin or Wertheim medium. While we are at 
our task since October, 1909, and have fully inves- 
tigated a great many cases, we know that we are 
far from knowing all there is to the living germs in 
the prostate. It would lead too far to enter into the 
details of our findings; they will be reported later, 
but we are even now sure of the following facts : In 
the search for pathogenic bacteria the microscopical 
examination of the prostatic fluid is not sufficient ; 
cultures must be made, because a microscopical 
examination of the smear may show no pathogenic 
bacteria, and yet after 24 hours we see on the culture 
media an abundant growth of staphylococci and even 
gonococci. 

The microscopical examination of the smears, 
mainly, however, the cultures prepared from the 
secreta are frequently surprising and very often not 
at all in conformity with the clinical symptoms. 
Gonococci, ordinary diplococci and staphylococci 
often appear to have a peculiar and intimate relation- 
ship to each other, and it is quite probable that the 
medium in which these organisms grow, whether 
that afforded by the diseased prostate, or any other, 
exerts a transforming influence and converts one form 
into another. This theory is so much more attract- 
ive as it would fully explain the frequent perplexing 
changes in the clinical symptoms of chronic prosta- 
titis. We have further found that in the absence of 



FORMS OF IMPOTENCE 137 

gonococci there appear almost invariably diplococci, 
morphologically like gonococci, but Gram positive. 

In connection with gonococci there are always 
staphylococci present. 

Dr. W. P. Willard of San Francisco, who made a 
close study of the Colon bacillus is of the opinion that 
many cases of originally gonorrheal prostatitis, that 
have existed for years, are kept active by a colon 
invasion. These organisms outgrow or replace the 
gonococci and keep up an infection of a low grade, 
which causes infiltration and gradual destruction of the 
glandular tissue. Willard has observed several cases 
of impotency of various degrees in patients affected in 
this manner, and after many examinations was only 
able to obtain the colon bacillus as the exciting factor. 

Of the diseases of the prostate acute inflammation 
and atrophy cause temporary or permanent im- 
potency. Chronic prostatitis, one of the most fre- 
quent consequences of gonorrhea, is also the most 
frequent cause of various sexual neurasthenic dis- 
turbances and of prostatorrhea ; it invariably dimin- 
ishes sexual inclination . The other diseases of the pro- 
stata have not been studied much in their influence 
on virility, as they generally make their appearance 
at an age when virility is of but small consideration. 

Patients frequently consult physicians and com- 
plain of various forms of chronic discharges. Most- 
ly they are told that there is no cause for worry as 
they have a " simple prostatorrhea." If we, how- 
ever, consider the importance of the prostatic 
gland and its secretions, and think of the signifi- 
cance of the internal secretion of various glands, 
we must come to the conclusion that a prosta- 



138 SEXUAL IMPOTENCE 

torrhea surely is not without a certain consequence, 
and ought to be remedied if possible. 

Diseases of the urinary bladder are apt to increase 
sexual desire temporarily, catarrh of the bladder, 
for instance, being frequently followed by greatly 
increased libido sexualis, which degenerates now and 
then into priapismus and satyriasis. This increase 
in sexual desire is still more frequently met with 
when the neck of the bladder alone is diseased, and 
in such cases the ejaculation is, as a rule, accom- 
panied with pain. Urinary calculi also nearly al- 
ways cause increased irritability in the sexual organs. 
Roubaud 1 says that the very rare prolapse of the 
urinal bladder through the inguinal canal causes im- 
potence, principally through the retraction of the 
penis occasioned thereby. 

Strictures of the urethra have different effects on 
virility. They very often cause impotence, and are, 
moreover, always a hindrance to fecundation. 

Superexcitation from disease of the sexual organs 
is generally followed by relaxation. The patient 
who suffers from gonorrhea is sexually excited; he 
could perform coition oftener than in the state of 
health if he were not withheld by the great suffering 
and the fear of the consequences; but when this 
state of irritation is past, reaction will set in. The 
unusual continence to which vigorous young men are 
forced by gonorrhea neutralizes the injurious influ- 
ence of over-excitement of the nerves, and, possibly, 
of the specific action of the virus of gonorrhea on 
the sexual nerves. Sometimes we see, as Ultzmann 2 

1 Op. cit. p. 255. 

2 Potentia generandi und Potentia cceundi. Wien, 1885, p. 24. 



FORMS OF IMPOTENCE 1 39 

says, that such patients who have formerly been 
virile in a high degree become temporarily impotent 
after an attack of gonorrhea, especially when the 
disease is accompanied by catarrh of the bladder, 
prostatitis, or orchitis. Ultzmann thought that in 
such cases gonorrhea has had a paralyzing effect on 
the nervous apparatus of the prostata. This con- 
jecture was admitted as perfectly well founded, and 
it was also supposed that the sexual nerves have 
become temporarily neurasthenic in consequence of 
the strain of the almost continuous state of excite- 
ment. Now we know that it is mostly chronic 
catarrh, irritation, inflammation, infiltration and 
what Buerger would call urethritis chronica cystica 
in and around the caput gallinaginis, the prostatic 
portion of the urethra, the prostate itself, and the 
vesiculae seminales that are most frequently the 
origin of functional disturbances. The peripheric 
ends of various nerves in connection with the centers 
of erection are kept in constant irritation, and pro- 
duce neurasthenic conditions, which in many cases 
outlive the original local disease. 

The influence of such local diseases, as a factor in 
causing sexual neurasthenia requires further careful 
observation and study. 

In spite of our modern and improved methods of 
examination we still meet a great number of sexual 
neurasthenics seeking medical aid who show no 
anatomical changes of any kind. But, it must be 
admitted that, the further we advance in the study 
of the deep urethra and the pathology of the various 
sexual appendages less frequently we see cases of 
genuine sexual neurasthenia. 



140 SEXUAL IMPOTENCE 

The endoscope has helped us to a knowledge of a 
number of diseases of the mucous membrane of the 
urethra, among which the affections of the colliculus 
seminalis and of its adjoining parts interest us in the 
first place, as they exercise great influence on virility. 
Griinfeld 1 told us first that endoscopic observation of 
the colliculus seminalis in different individuals dis- 
closes varieties differing widely in color, size, con- 
sistency, and vascularity. These differences rest on 
a pathological basis. Finger's microscopic and 
endoscopic observations 2 were of the greatest import- 
ance; they form a true and valuable foundation for 
a pathological anatomy of the impotentia cceundi. 
His meritorious work was continued by others. 
Wossidlo, 3 whose endoscope is one of the best, pub- 
lished a report upon 103 cases, in which lesions of the 
verumontanum were prominent. All of these patients 
complained of various neurasthenic symptons. 

Simultaneously came Swinburne 4 with his report 
upon disturbances due to disease of the verumon- 
tanum and its treatment with the posterior urethro- 
scope. 

Very promising and valuable contributions to the 
knowledge of the pathological conditions of the deep 
urethra are those by Buerger 5 who with his cysto- 

1 Die Endoskopie der Harnrdhre und Blase. Deutsche Chi- 
rurgie, Stuttgart, 1881, Lief. 51, p. 172. 

2 Finger, op. cit., pp. 51 to 57. 

3 Zeitschrift fur Urologie, 1908, No. 3, p. 243 

4 Annals of Surgery, Sept., 1908. 

5 On New Methods of Diagnosis and Treatment of Lesions 
of the Neck of the Bladder and Posterior Urethra. Am. 
Jour, of Dermatology and Gen. Ur. Diseases, 191 1, No. 1. 



FORMS OF IMPOTENCE 141 

urethroscope has placed in the hands of the modern 
urologist an instrument signally suitable for the 
examination of the posterior urethra and the neck of 
the bladder. 

Buerger found two types of cystic disease of the 
neck of the bladder and the posterior urethra. The 
first and most common of these, he thinks, is un- 
doubtedly an inflammatory process, the end result 
of gonorrheal inflammation, while the second pre- 
sents itself in the form of simple lesions of re- 
tention, belonging to the involution of the senile 
period. 

The size of the cysts varies considerably, having a 
diameter of about a millimeter up to 5 millimeters 
or more, and the mucous membrane upon which they 
lie, or better, are imbedded in, he found usually 
thickened and velvety. 

Buerger found that the clinical symptoms in these 
cystic cases vary considerably, from a simple morning 
drop without any other complaint to frequent, even 
painful urination, to various neuralgic pains, im- 
potence, premature ejaculation, etc. And his find- 
ings tally exactly with the extensive observations I 
made with Goldsmith's endoscope ; and I would only 
add, that we can frequently find considerable patho- 
logical changes in and around these regions and have 
no clinical symptoms whatever, while the gravest 
cases of impotence may seemingly be caused by some 
trifling catarrhal swelling. Evidently the nervous 
systems of different persons react quite differently 
as a result of pathological changes. 



142 SEXUAL IMPOTENCE 

Geraghty 1 of Baltimore, in confirming Wossidlo's 
findings calls attention to pathological conditions of 
the prostatic utricle and the mode of treating them 
with his cauterizing syringe. 

Pain of various degree at the time of ejaculation is 
always a sign of some structural change in one or 
more of the organs participating in the ejaculation. 
So far, while many of my patients complained of 
more or less pain, I have never seen a case painful 
enough to compel the patient to refrain from coition. 
TVbssidlo and Geraghty, however, both describe such 
conditions. 

In all cases of painful ejaculation observed by me 
the pain was invariably more intense after more or 
less prolonged, or even after only relatively prolonged 
abstinence, and diminished or even disappeared 
when coitus was repeated after a shorter interval. 

It is quite probable as Geraghty says, that the 
sudden distension of an inflamed utricular wall may 
produce the sudden sharp pain when the seminal 
fluid is thrown into this cavity. This would easily 
explain that when the seminal fluid becomes less 
concentrated the pain will also become less, not 
considering that repeated distentions will by them- 
selves lessen the pain at each following one. 

Continued investigations have thus proven that 
the various diseases of the sexual functions of man 
are not to be reduced to affections of the nerve- 
apparatus exclusively, but that they, even more fre- 
quently depend on structural diseases of the collic- 

1 A Method of Treating the Prostatic Utricle. Jour. A. M. 
A., March n, 191 1. 



FORMS OF IMPOTENCE 143 

ulus seminalis and its neighborhood. We observe 
hyperemia, catarrhal swelling, hypertrophy, cysts, 
papillomata, thickening and various degrees of infil- 
tration of the verumontanum. With anemia we 
generally find also a condition which I would call 
nabbiness of the whole structure. 

Other diseases of the sexual organs do not affect 
virility. Cancerous or tubercular degeneration of 
the testicles does not impair the sexual power. I 
have often had opportunities to examine the ejacu- 
lated semen of persons afflicted with tuberculosis of 
the testicle, and never found spermatozoa therein; 
but the patients, subject almost without exception 
to frequent pollutions, were perfectly virile. 

Physicians should, however, always bear in mind 
that several forms of genital tuberculosis are causing 
chronic and so-called incurable urethral discharges, 
and that not every chronic urethritis is due to gonor- 
rhea and its complications. Even when patients 
show no symptoms of failing health or emaciation, a 
persistent urethral discharge is always suspicious, 
and the genital organs should be examined for tuber- 
culosis, because some persons may suffer with ad- 
vanced genital tuberculosis and still show no impair- 
ment of their general condition. 

The opinion that the tuberculosis of the male geni- 
tal organs is mostly ascending, gains more and more 
ground, von Biingner 1 recommends therefore high 
castration by evulsion of the vas deferens. 

1 Ueber die Tuberculose der mannlichen Geschlechtsorgane. 
Beitrage z. klinischen Chirurgie., 1902, p. 1. 



144 SEXUAL IMPOTENCE 

Keyes 1 thinks sterility to be frequent at the time 
the first testis is invaded, and recommends for such 
cases the removal of both epididymes. 

Some older French authors, and among them 
Lallemand, claimed that varicocele can cause impo- 
tence. Confirming Lallemand' s descriptions we find 
the testicle of the affected side, which is almost 
invariably the left one, somewhat enlarged and soft- 
ened, while later on various degrees of atrophy may 
develop. The patients are seldom vigorous in 
sexual matters, and are very much disposed to gonor- 
rheal and traumatic inflammation of the epididymis. 

Lydston 2 reported a case of impotentia cceundi 
due to cavemositis chronica. The patient, above 
middle age, complained of curvature of the penis 
during erection. Lydston considers the sclerosing 
inflammation of the corpora cavernosa a local symp- 
tom of general arteriosclerosis. While arterioscle- 
rosis may have been the etiologic factor in Lydston 's 
case, I have found syphilis to have caused sclerotic 
alterations in the corpora cavernosa in three cases 
I observed since 1905. All three were men over 
fifty years old, the lesion was always in the dorsal 
part of the corpus cavernosum urethra?, anti- 
syphilitic treatment arrested the process, and, by 
diminishing the induration, brought considerable 
relief. One patient referred to me by Dr. Steltzner of 
San Francisco was a man of fifty-nine years, and 
while admitting early luetic infection, refused proper 

1 Tuberculosis of the testicle. Am. Jour, of Urology, April, 

1907, p. 149- 

2 Med. Fortnightly, St. Louis, May n, 1908. 



FORMS OF IMPOTENCE 1 45 

treatment, claiming that he was cured years ago. 
He went to Germany for help, but did not find it. 

In 1 91 2 I treated a man of sixty, who gave a 
somewhat hazy history of infection in youth, and 
had undergone during three years various treat- 
ments at the hands of several physicians ; he finally 
refused to be circumcised, as even his layman's 
reasoning told him that such an operation could not 
possibly be of any influence upon the hardening in 
his penis and the subsequent curvature during erec- 
tion. In his desperation he wrote to Dr. Ackermann 
of Wheeling, West Virginia, who referred him kindly 
to me. 

It was almost with awe that several years ago I 
approached the question of the relations of internal 
secretion of the various glands and the sexual func- 
tion. There is at present a tendency to blend the 
two principal theories that certain ductless and 
other glands either provide the blood with sub- 
stances necessary for the normal functions of other 
organs, or produce substances which act as an 
antitoxin against noxious products of metabolism 
of other organs. Many cases of inexplicable weak- 
ening of the sexual power will certainly be better 
understood when we know more about this one, 
probably the biggest problem of modern medicine. 

Albert Abrams kindly wrote the following state- 
ment: "One of the most important recent develop- 
ments in medicine concerns the functions of the 
ductless glands, which have heretofore been regarded 
as negative factors in the welfare of the organism. 
It has been repeatedly demonstrated that the glands 
10 



I46 SEXUAL IMPOTENCE 

in question elaborate specific chemical products 
known as hormones, which are manufactured in one 
organ of the body and are conveyed by the blood to 
another organ or organs where they stimulate physio- 
logic activity by their presence. 

"The hormone manufactured by the testes at 
puberty instigates the metabolic changes peculiar 
to the male at that period. This testicular hormone 
also influences osseous development insomuch as one 
finds in young men with atrophied testicles, and in 
eunuchs an overgrowth of the long bones caused by 
delayed epiphyseal ossification. 

"Similarly, the hormone of the ovary creates 
changes peculiar to puberty in the female. 

"Recent investigations concerning the hormones 
of the pituitary body are specially interesting. 

"The pituitary gland consists of two lobes; an 
anterior glandular, and a smaller posterior body 
made up essentially of nervous elements. 

"The hormone developed by the posterior lobe 
has a diuretic action and raises blood-pressure by 
vasoconstriction. Complete removal of the gland 
in dogs resulted in death preceded by a peculiar 
group of symptoms (cachexia hypophyseopriva) . 
Partial removal of the anterior lobe caused increased 
deposits of fat, polyuria, glycosuria and diminished 
activity of the sexual function. Diminished activity 
of the pituitary gland conduces to obesity and sexual 
infantilism, whereas the hormone of the anterior 
lobe augments the katabolism of fat, the growth of 
bones and stimulates sexual development." 



FORMS OF IMPOTENCE I47 

Ott 1 says in regard to the thyroid and the supra- 
renal the following: 

"In myxedema there is a want of development in 
the cartilages of the epiphyses, an atrophy of the 
genital organs, ovaries and testicles, showing a rela- 
tion between the thyroid function and the genital 
functions. 

"Sexually precocious children have hypertrophied 
suprarenal capsules. Atrophy of suprarenal cap- 
sules is associated with want of pubic hair and of 
development of the genital organs. Hence the cor- 
tex of the adrenal is probably connected with the 
growth of the body and the development of puberty 
and sexual life." 

There is a great number of poisons, medicaments, 
and foods which diminish virility temporarily or 
permanently. Some manifest their injurious effect 
after a short and moderate use ; others do not show 
themselves until after a longer or immoderate use. 
In this respect we meet the most contradictory state- 
ments in medical works. Very often one author 
quotes the assertions of another. These contrasts 
are, however, easily explained if we take into account 
the difference of the effect of one and the same medi- 
cament on different individuals. Take, for instance, 
quinin, the remedy most generally used until recent 
times. The same dose given to two equally vigorous 
men may cause in the one scarcely a slight tinnitus 
aurium and in the other the most unpleasant effects. 

Alcohol, especially, exhibits its action on different 
individuals differently. There are people who in a 

1 Op. cit., p. 404. 



148 SEXUAL IMPOTENCE 

rather high degree of intoxication can accomplish the 
act of coition, while with others the sexual organs 
are completely paralyzed by the consumption of so 
small a quantity of alcohol that it would not affect at 
all the functions of the other organs of the body. 
Thus we see that in this respect it would not be safe 
to lay down general rules and apply them in all 
cases. 

Alcohol in general diminishes the sexual power, 
according to the strength of the article consumed. 
Alcohol is least concentrated in beer, and yet beer 
is, as a matter of fact, very unfavorable for virility. 
Gallant ladies are well aware of this, and it is only an 
exception for them to serve beer to their lovers. Too 
hasty an ejaculation may be delayed by a moderate 
consumption of beer, 1 while an intemperate absorp- 
tion of the same liquid will hinder erection. 

But why is beer disadvantageous to coition? Al- 
cohol is of consequence only when consumed in large 
quantities, and yet we see that very light qualities 
of beer are perhaps worse for virility for the time 
being than heavy beer. Lupulin cannot be of impor- 
tance either, as the quantity is too insignificant, and 
in cases where the efficacy of lupulin is desirable, it is 
generally without effect. Therefore the effect of 
lupulin is not so prompt and sure as that of beer. I 
think that, in an immoderate consumption of beer, 
both alcohol and lupulin (?) are of less importance 
than the great quantity of liquid consumed, which 
causes frequent urination and has a relaxing effect 
on the parts under consideration. Dr. Lehmann, of 

1 Curschmann, op. cit., p. 535. 



FORMS OF IMPOTENCE 149 

Munich, 1 ascribes the diuretic effect of beer to the 
greater quantity of liquid, assisted by the influence 
of alcohol upon the heart. It is noticeable that erec- 
tion is slower immediately after urination than some 
hours later. This observation suggests that sexual 
organs active in erection may be temporarily dis- 
turbed in their function by the evacuation of large 
quantities of urine, repeated at short intervals. 

A moderate consumption of beer is rather advan- 
tageous for the act of coition, and, in wedlock, where 
I ascribed the absence of children to a possible fri- 
gidity of the wife, I have advised the husband to take 
some beer before coition, because I thought that by 
thus prolonging the act the wife might be roused out 
of her reserve and become more liable to conception. 
The result has justified this supposition in one case at 
least. These observations would also help to ex- 
plain the large families in countries where beer is the 
habitual beverage, as in Bohemia and Bavaria. 

The effect of wine in this respect is exceedingly dif- 
ferent, varying with the kinds of wine as well as with 
the individuals consuming them. Here again my 
observations have proved that wines with diuretic 
tendency affect the sexual capacity for the time being 
more than do other wines. Some strong, dark- 
colored wines, such as certain kinds of Calif ornian, 
Bordeaux, Malaga, Dalmatian, Sirmian, etc., and 
also some of the stronger white wines, especially the 
Muscatel, if consumed moderately, have almost an 
aphrodisiac effect; while others, and particularly 

1 Die Ursache der bekannten diuretischen Wirkung des Bieres. 
Wiener med. Presse, 1887, No. 42. 



150 SEXUAL IMPOTENCE 

champagne, exercise an almost paralyzing influence 
on the centers of erection, or, directly, on the appa- 
ratus of erection, as they increase the libido sexualis, 
but check the erection. 

In brandy and liquors the quantity of alcohol only 
comes into consideration, and, though it may be 
larger than that in wine or beer, it tends to increase 
rather than diminish the sexual power, if the same 
time for subsidence has been allowed in both cases of 
consumption. 

At any rate, the ancient Latins were right only as 
far as the woman is concerned when they said, "Sine 
Cerere et Baccho friget Venus," "Luxuriosa res 
vinum," "ut vino calefacta Venus, turn ssevior ardet 
luxuries," etc. 

Considering the first exciting and subsequent sed- 
ative effect of coffee and of tea, an immoderate use of 
the same might injure virility. Guelliot 1 speaks 
of sexual impotence in the male, and profuse leucor- 
rhea in women as prominent symptoms of chronic 
coffee poisoning. I have observed that an average 
sized cup of good and medium strong coffee acts as a 
mild aphrodisiac in many cases, and mainly with 
persons who are not using this beverage in excess. 
No doubt that this one, as well as all other stimulat- 
ing food or drink, may fail to have any effect in some 
cases. 

Some authorities assert that smoking is injurious 
to virility, but it is very difficult to form a correct 

1 Compare Leszynski: Coffee as a beverage, and its frequent 
deleterious effects upon the nervous system, etc. Medical Rec- 
ord, Jan. 12, 1 90 1. 



FORMS OF IMPOTENCE 151 

opinion. Schtscherbak's searching investigations 
regarding the influence of tobacco on the nervous 
centers 1 have resulted only in the assertion that 
immoderate smoking, like the internal use of nicotin, 
undoubtedly affects the nervous centers; but it is 
difficult to determine what influence is exerted on 
the centers of the sexual functions. In acute intoxi- 
cation with nicotin, copulation is out of the question, 
but when the symptoms of poisoning have passed, 
virility is exactly in the same condition as before. 
Chronic intoxication with nicotin, to which one may 
be addicted for many years with impunity, seems not 
to injure virility, as very great smokers may indeed 
be quite as great in sexualibus. A thirty-year-old 
Servian told me he had found that his virility 
was seriously injured when he discontinued smok- 
ing cigarettes. This might, however, be merely 
imaginary. 

The habit of snuff -taking, now becoming less com- 
mon, is more likely to injure virility, as it weakens 
the sense of smell, and the odor of woman plays an 
important role in sexual matters, as is well known. 
Galopin, 2 speaking of snuff-takers, says, "If they are 
gourmands, they deprive themselves of the bouquet 
of their dishes and wines ; if they are young and vig- 
orous, they deprive themselves of the pleasant odor 
of a beloved wife or mistress, as well as of a thousand 
pleasures which the olfactory sense of a clean and 
healthy man procures. " But snuff users have little 

1 K voprosu o vlijaniji nikotina i kurenija tabaku na nervnie 
cen.tri. Vratch, 1887, Nos. 4-9. 

2 Le parfum de la femme. Paris, 1886, p. 39. 



152 SEXUAL IMPOTENCE 

chance with ladies nowadays, as they unquestion- 
ably diffuse a disagreeable odor about themselves. 

There are foods, solid and liquid, that are said to 
cause temporary impotence, but, in my opinion, this 
rests more or less on popular belief only; and, after 
all, virility must be at a low ebb when it can be 
checked by eating Lima beans, lettuce, etc. 

There are many popular means of subduing amor- 
ous desire for a time. In Bosnia the moon-flower, 
under the name of "Neven," is highly prized as a 
powerful anaphrodisiac. Women make their hus- 
bands take it in the form of medicine, and they also 
put the blossoms among the linen of husbands about 
to go on a journey. 

In France digitalis is said to have similar renown, 
and Campbell Black finds this virtue of digitalis very 
comprehensible, as it stimulates Remak's fibers. 

We meet with the most contrary statements about 
medicaments reputed to have an injurious influence 
on virility. Our best observations are on morphin, 
which, according to Levinstein, 1 after first increasing 
sexual excitability, affects it finally in the opposite 
manner. An injection of morphin always has, on 
persons who are not accustomed to it, the effect of 
increasing sexual excitement and vigor. Rosenthal 2 
states that injections of morphin of medium strength 
(0.03-0.06 per day) produce unusual hilarity and af- 
fability, heightened sexual excitability, increased re- 

1 Morphiumsucht. Berlin, 1887, p. 93. 

2 Untersuchungen und Beobachtungen iiber Morphiumwir- 
kung. Wiener med. Presse, 1886, No. 49. 



FORMS OF IMPOTENCE 1 53 

finement of the sense of touch, etc. — all symptoms 
little known and appreciated. 

In Persia opium is said to be used as an aphro- 
disiac. 1 This is in accord with the observations 
made on opium- smokers, who are extraordinarily 
vigorous sexually at first, their virility beginning to 
fade when the general marasmus always following 
this fatal habit reaches a certain degree. L. Pass- 
over 2 besides, observed that the long-continued use 
of morphin leads to atrophy of the genitals. 

Morphin, opium, and cannabis Indica have long 
since ceased to be used for therapeutic purposes only, 
there being a large number of persons for whom the 
very extensive use of these drugs has become an in- 
dispensable necessity. Opium- smokers and hashish- 
eaters sing real hymns 3 of praise to these poisons. 
These poisons are, indeed, pleasant and sure means 
of suicide for unhappy people or people weary of life 
in this world. Their habitual use can be recom- 
mended to those only who desire to commit suicide. 
Paralyzing the inhibitory nervous centers in the 
brain, they probably thus increase virility at first. 

Albert Abrams recommends that about eight drops 
of laudanum tincture be given previous to intercourse 
in cases of fear predominating the sexual act. It is 
sometimes just as effective as a large dose of bromid. 

There are also the most contradictory statements 
concerning the influence of arsenic and its prepara- 
tions on the virile power. Although arsenic has a 

1 Rosenthal, op. cit., p. 147. 

2 Wiener Med. Presse, 1893, No. 7. 

8 "Oh, just, subtle, and mighty opium!" 



154 SEXUAL IMPOTENCE 

different effect on different individuals, and may 
therefore affect their sexual powers differently, yet I 
must state that in the very frequent use I have made 
of arsenic in various diseases, even for years continu- 
ously, I have never ob served a diminution of sexual 
vigor. I never saw a change in the sexual power of 
men or in the amorous desire in women, even in 
cases where arsenic had some disturbing effect, or 
where it did not produce the desired change in the 
disease under treatment, and its use had, in conse- 
quence, to be discontinued. On the contrary, sev- 
eral of my patients, who owe the return of health to 
arsenic, have with their health also recovered their 
virility; so that I do not hesitate to recommend ar- 
senic, in conjunction with other remedies, of 
course, in certain cases of prostration, and also in 
impotence when it has been brought on by such 
prostration. 

Rosenthal 1 asserts that arsenic exercises an un- 
favorable influence on the sexual power after con- 
tinued use; but this is so only with the inhabitants 
of towns, while the inhabitants of Alpine regions 
have children in spite of the consumption of consid- 
erable arsenic. This, indeed, seems too improbable. 
The same writer observed recover}- of sexual sensibil- 
ity at the beginning of the use of arsenic. 

Lead-poisoning, especially if acute, occasionally 
causes impotence. As physician of a large associa- 
tion of typographers I had, for a number of years, the 
opportunity to convince myself of the excellence of 
the observations made by Tanquerel des Planches, 

1 Op. cit., p. 151. 



FORMS OF IMPOTENCE 1 55 

and of those made more recently by Roubaud. 1 I 
never noticed a diminution of virility in chronic lead- 
poisoning that was not accompanied by some other 
effect on the nervous system. 

Long-continued use of iodin can produce atrophy of 
the testicles, besides that of other glands; but 
such cases are exceedingly rare, and entirely denied 
by some very experienced syphilologists. I have re- 
cently had several cases where the use of potassium 
iodid had exerted a very unfavorable effect on virility. 

Prolonged use of mercury also is said to lead to 
atrophy of the testicles. Roubaud 2 has observed 
this in the case of laborers who work with mercury. 

Salicylic acid and its preparations unquestion- 
ably impair sexual vigor, but only temporarily. 
My observations have convinced me that men are 
temporarily more or less impotent during the use of 
salicyl and its salts, which are so frequently em- 
ployed. The experiments made by Kolbe and Dr. 
Lehmann, 3 in Munich, to prove the harmlessness of 
salicylic acid, have not had any results with regard to 
its effect on virility. 

Camphor, lupulin, antimony, niter, and the bro- 
mids are also said to have an unfavorable influence 
on sexual vigor. Krafft-Ebing 4 says in this respect, 
"Our nomenclature presents a large list of anaphro- 
disiacs, but when we practically try all these reme- 

1 Op. cit., p. 240. 

2 Op. cit., p. 285. 

3 Beitrag zur Frage der Gesundheitsschadlichkeit der Salicyl- 
saure. Med.-chir. Rundschau. Wien, 1887, Heft 14, p. 549. 

* Die Therapie der Geisteskrankheiten. Wiener med. 
Presse, 1801, No. 22. 



I56 SEXUAL IMPOTENCE 

dies we soon convince ourselves that they have no 
such virtue, or very little. This is true, for instance, 
of camphor, belladonna, and lupulin. Of somewhat 
more value are the bromids in large doses. No 
effect must be expected from doses of less than six 
grams. 

"Monobromated camphor seems to be of quite 
exceptional value as an anaphrodisiac. Lupulin is 
not to be entirely disregarded ; only it must be given 
in doses of over one gram each, if any effect is 
desired. 

"Recently antipyrin has been employed as an an- 
aphrodisiac, and in doses of two grams it is said to ex- 
ert a sedative effect on the sexual apparatus. Ham- 
mond and a few others direct our attention to the 
anaphrodisiac effect of sodium nitrate. Quite re- 
cently I have treated painful sexual excitation with 
doses of three grams of sodium nitrate pro die, 
and have succeeded in reducing it to a minimum 
thereby." 

Here I may be allowed to state that in the first 
German edition of this work, which appeared in 1889, 
I directed attention to antipyrin as a possible an- 
aphrodisiac, saying, "Experiments made on animals 
having proved that antipyrin has an irritating in- 
fluence on the inhibitory reflex centers, it would 
be very interesting to examine its influence on 
erectility." 

Van den Corput has ascertained that, besides sali- 
cylic acid, quinin, menthol, phenol — indeed, almost 
all antiseptics — diminish sexual vigor in a marked 
degree. He considers that this fact may have its 



FORMS OF IMPOTENCE 1 57 

explanation in the inhibitory influence which these 
substances exert on the formed elements of the blood 
and on the spermatic cells in the same manner as on 
the lower organisms. The microscope shows, more- 
over, that these substances render the zoosperms 
perfectly motionless. According to Van den Cor- 
put, the diminished sexual vigor is to be ascribed to 
anesthesia and paralysis of the centers which govern 
the sexual function, as well as to the sterilizing and 
antivital influence which the antiseptics have on the 
spermatozoa. 

William J. Robinson 1 reports a well observed and 
unmistakable case of impotence caused by the ex- 
cessive consumption of br omo- seltzer . 

A. Riviere, 2 of Lyon, submitted two obese and 
arthritic men of thirty-four and thirty-six years, re- 
spectively, to the treatment with Thyroidine. Both 
patients lost considerably in weight, but suffered at 
the same time from sexual impotence, which did not 
leave them until some time after this organic extract 
was discontinued. I have observed a similar effect 
in a man twenty-eight years old, who took the 
Thyroidine tablets for a skin-disease. 

It is reported 3 that the use of suprarenal prepara- 
tions has a similar effect, rendering the maintenance 
of erection almost impossible; this influence being 
also transitory, passing off some time after the 
cessation of the use of the drug. 

Dr. Arthur Strauss 4 claims that heroin in o.oi 

1 Journ. Am. Med. A., Aug. 18, 1906, p. 508. 

2 La Semaine Medicale, April 23, 1898. 

3 N. Y. Med. Journ., Oct. 19, 1901, p. 763. 

4 Munchen. med. Wochenschr., 1902, No. 36. 



158 SEXUAL IMPOTENCE 

doses acts as a good anaphrodisiacum. Becker 1 is 
of the same opinion. 

INHERITED PREDISPOSITION TO IMPOTENCE. 

There is an apparent inconsistency in speaking of 
inherited impotence, and yet the physician meets 
with many cases of sexual weakness and abnormal 
conditions of the sexual desire which after closer ex- 
amination he cannot but trace to inheritance as the 
original cause. Hoffmann 2 says, in this respect, 
"It is a fact that there are men who from their 
birth either lack the incitomotor impulse which 
dominates over the sexual functions, especially 
erectility, or in whom it appears abnormally im- 
paired." 

It is quite conceivable that such a condition can 
occur in an otherwise normal state, this condition 
having been called by the ancient Canonists, who 
were very expert in such matters, "Natura frigida." 

Those individuals are indeed very scarce who dis- 
play complete inertness of their sexual life, although 
possessing sexual organs quite normal in develop- 
ment and function. 

Krafft-Ebing 3 says that individuals possessed of 
weak sexual power, in whom the lack of sexual in- 
stinct can be traced to the cerebrum, are very rarely 
met with, and are probably without exception de- 
generate beings in whom may be found other dis- 
turbances in the function of the cerebrum, psychi- 

1 Berlin, klin. Wochenschr., 1903, No. 47. 

2 Lehrbuch der gerichtlichen Medicin. Wien, 1881, p. 53. 

3 Psychopathia sexualis. Stuttgart, 1886, p. 29. 



FORMS OF IMPOTENCE 1 59 

cally degenerative conditions, and even signs of 
structural deterioration. 

There are numerous families the male members of 
which are conspicuously weak in sexualibus. These 
are not always sickly people, but now and then are 
robustly built and of healthful appearance; most of 
them have very light complexions and high-pitched 
voices, and very often show no other weakness than 
that of the sexual organs and functions. 

Sometimes we may see a man whose father was 
sexually very powerful, but who was begotten at a 
time when the father's virility was already on the de- 
cline — i.e., when he was partially impotent in conse- 
quence of unwise management of the sexual power, 
though it may have been originally great. 

Circumstances like the above will not surprise any 
one who is acquainted with the laws of transmission 
by inheritance, and who knows that, besides forms, 
qualities and habits also may be inherited. Even 
recollections are said to be thus transmitted, this as- 
sertion coming from a competent source, Exner. As 
fertility, for instance, and the early or late appear- 
ance of menstruation can be transmitted from 
mother to daughter, so also may a son receive from 
his father, by way of inheritance, sexual power or 
weakness. 

Haeckel has attempted to formulate laws of inher- 
itance, and, among other things, he says, "In all 
organisms with separated sex, the primary and 
secondary sex-characteristics are inherited one- 
sidedly — i.e., the male descendants resemble the 



l6o SEXUAL IMPOTENCE 

father in the aggregate of the essential sexual 
characteristics while the females resemble more the 
mother." 

Just as there is a great difference observable in the 
sexual impulse in different nations, so there are very 
great differences to be noticed in the ardor with 
which the sexual instinct announces itself in differ- 
ent families. There are sundry links of connection 
whereby nature subdues the different degrees that 
might otherwise be too striking. These combina- 
tions of physiological and psychological phenomena 
are commonly called the temperament, and we all 
know that children have generally the temperament 
of one or the other or even of both the parents. 

An innate sexual weakness shows itself frequently, 
yet not always, in the conformation of the genitals. 
Although the structure may be quite normal, they 
are nevertheless of an abnormal flabbiness and pale- 
ness. The erectile tissue is not very firm; the pre- 
puce — if there is not a positive phimosis — is thin and 
moves with difficulty over the glans. Such indi- 
viduals are generally unassuming, and make true and 
devoted husbands; nothing in them could incite 
them to act otherwise. 

In most cases this weakness can be traced back 
to childhood, when incontinentia urinae existed, and 
there is no denying the connection between sexual 
weakness and incontinence of urine. This connec- 
tion Lallemand discovered with that perspicacity 
peculiar to him. I have always found that children 
suffering from incontinence of urine had unusually 



FORMS OF IMPOTENCE l6l 

small genitals, and when I found an adult affected 
with the above disease, he invariably was either quite 
or almost impotent. 

Men who suffer from congenital weakness of the 
sexual organs are not inclined to excesses in venery, 
as has already been stated ; but with them the most 
severe consequences may be brought about by sexual 
indulgence to an extent not considered immoderate 
with others. In such persons insignificant excesses, 
or onanism practised for a short time, will result in 
frequent, and to a certain degree incurable, involun- 
tary seminal losses together with a great enfeeble- 
ment of every sexual power. 

The different grades of sexual weakness are in- 
numerable, and while one man may scarcely show 
any signs at all, another exhibits from the very be- 
ginning the most decided sexual decrepitude. We 
shall therefore be right in asserting that the different 
degrees of sexual vigor, or of resistance against ex- 
cess in venery, rest principally on hereditary differ- 
ences ; for sexual vigor or weakness is oftener inher- 
ited than is usually admitted. 

The individual differences in sexual feelings and 
sensations are perfectly obvious. One individual 
may live for sexual enjoyment alone, all his actions 
keeping in view that one main object — viz., sexual 
gratification, which he enjoys to a degree of ecstasy. 
Another may remain almost indifferent in regard to 
love and woman, may consider coitus a necessary 
evil, and while performing it may be thinking of 
some other affair. 
ii 



1 62 SEXUAL IMPOTENCE 

You may meet with individuals who, with robust 
constitutions and well-developed genitals, have from 
their youth shown comparatively little taste for 
sexual enjoyment — individuals who are not easily 
tainted by the bad example of onanism, and who, 
later in life, exhibit a certain reserve in respect to the 
other sex. With some, and they are probably rare 
exceptions, this absence of sexual desire has even 
reached the point of disgust. Such men are shocked 
by a somewhat licentious expression; they are 
amazed at the excesses of others, and look upon love 
merely as the means of bringing forth children. This 
congenital disinclination for sexual pleasure is called 
frigidity, and may become an obstacle to virility, or 
it may render copulation possible only under spe- 
cially favorable circumstances. 

Krafft-Ebing 1 ranks this frigidity among the neu- 
roses that have their seat in the brain, and calls it 
anesthesia sexualis, absence of sexual instinct, which 
renders ineffectual every organic impulse starting 
from the organs of generation, as well as every fancy, 
every visual, auditory, and olfactory sensation 
that such individual may experience in this one 
direction. 

Only congenital frigidity can prove a serious hin- 
drance to the development of virility, while frigidity 
which is sometimes the result of a certain mode of 
education readily yields to the first sexual desires 
that assert themselves positively; here principles, 
resolutions, and vows give Way. 

1 Op. cit., p. 25. 



FORMS OF IMPOTENCE 1 63 

Sometimes we see whole families in whom educa- 
tion has implanted principles that will ever be an 
obstacle to the proper development of the sexual 
instinct, and thus, indirectly, of sexual vigor; 
though it frequently happens that one or the other 
member of such a family turns out to be a regular 
black sheep in sexualibus. 

Here we must also consider the "only" and 
the "favorite child wrongly brought up." Brill 1 
says: The only child, "a morbid product of our 
present social economic system," usually an off- 
spring of wealthy parents, who, having been them- 
selves brought up in luxury and anxious that their 
children should share their fate, refuse to have more 
than one or two children. By their abnormal love 
they not only unfit the child for life's battle, but 
prevent him from developing into normal manhood, 
thus producing sexual perverts and neurotics of all 
descriptions. 

Again, there are individuals who, with vigorous 
constitutions, normal development of the genitals, 
and very energetic sexual desires, nevertheless be- 
come temporarily impotent, where we can find no 
other cause than an inherited general or sexual nerv- 
ousness which, at the given moment, either excites 
the inhibitory centers of erection to an abnormal ac- 
tivity or sets the nerve-centers of erection out of 
function. Persons of this category are mostly from 
families where cerebral and nervous diseases are 
hereditary; albeit Beard asserts that children of 

1 Psychanalysis, Saunders, Philadelphia and London, 19 14, p. 291. 



164 SEXUAL IMPOTENCE 

neurasthenic parents are generally unaffected in that 
direction. The children will probably remain healthy 
when parents suffer from acquired neurasthenia; 
but when this disease itself is congenital or has ap- 
peared in the place of some other hereditary disease 
of the brain or nerves, then there is no doubt that 
such conditions are transmitted from generation to 
generation. No one can assert that there are no 
neurasthenic children. 

In general, the disposition to neuroses shows many 
varieties. There are persons who can make enor- 
mous exertions in mental, physical, and sexual mat- 
ters without being affected by neuroses, while a high 
degree of neurasthenia will visit others after only a 
slight effort in these directions. Therefore the dif- 
ferent injurious acts must be considered as bringing 
about the occasion for the disease, while the posi- 
tive or effective and real cause must be looked for in 
the congenital predisposition to nervous diseases. 
Perfectly robust and vigorous persons may be af- 
fected by this predisposition in a very high degree. 
The special predisposition to neurasthenia may be so 
intense that moderate, nay, even infrequent, inter- 
course has an injurious effect. 

A similar condition is observed in epileptics, 
though very seldom, it is true. I have known such 
an unfortunate one who had an attack after every 
ejaculation of sperm. Continued use of potassium 
bromid quelled the sexual activity and stopped the 
attacks ; but whenever a pollution took place, it was 
followed by an epileptic attack, however large a dose 



FORMS OF IMPOTENCE 1 65 

of potassium bromid or sodium bromid had been 
taken. In such cases, which occur but rarely, cas- 
tration may be suggested. 

Of the limited number of forms of congenital impo- 
tence we have yet to mention one — viz., perverse 
sexual sensation. This disease is mostly congeni- 
tal, the severe forms always; while the lighter forms 
may also be acquired. The subjects are generally 
persons affected by psychopathia, who can satisfy 
their sexual desire only in a peculiar manner. Such 
persons are not impotent in the true sense of the 
word, as erection is not lacking with them, but is 
often very vigorous, and yet they must be called im- 
potent because they are not capable of performing 
coitus in the normal way. 

Krafft-Ebing gave in his well known work, which 
we have repeatedly quoted, an exhaustive description 
of sexual psychopathy, and he classes the perverse 
sexual sensation (which he calls the paresthesia of 
sexual sensation) together with the sexual neuroses 
having their seat in the brain. Magnan 1 endeavored 
to classify the various forms of diseased sexual in- 
stinct, and, localizing them in the central nervous 
system, distinguishes four groups. 

Keeping in view the object of this work, we shall 
be very brief in discussing this disease, though it is 
both important and interesting to every physician. 
Numerous observations and investigations were re- 
quired to lead to a knowledge of this form of disease ; 

1 Des anomalies, des aberrations et des perversions sexuelles 
Paris, 1885. 



1 66 SEXUAL IMPOTENCE 

a study carried on during centuries was necessary to 
protect many an unfortunate being from punish- 
ment because of disease. Even in our day there is 
much to be learned before a correct opinion can be 
formed of many a case of this sort. On the other 
hand, we must guard against being misled by a false 
love for humanity. Society is in the right to protect 
itself against dangerous individuals, and it is justi- 
fied in destroying persons who assuage their amor- 
ous longings in murder and other acts of cruelty. 

Krafft-Ebing holds that, in paresthesia of sexual 
sensation, the spheres of sexual fancy are perversely 
accentuated by the association of feelings which 
otherwise would physiologico-psychologically awaken 
disgust, being accompanied by pleasurable sensa- 
tions; this association may reach so high a degree 
as to become passion. The result will be perverted 
actions. This occurs the more readily when the 
pleasurable sensations, having reached the height 
of passion, inhibit or overpower adverse ideas with 
corresponding unpleasant sensations; also when 
these latter cannot be roused at all on account of 
lack or loss of the moral, esthetic, and righteous per- 
ceptions. I am of the opinion, however, that Krafft- 
Ebing goes too far when he says, farther on, "We 
must declare as perverse every manifestation of the 
sexual instinct which is not in accordance with the 
aims of nature — i.e., with propagation." At any 
rate, Krafft-Ebing does not mean to say that any and 
every copulation not undertaken for the purpose of 
propagation must be declared as a manifestation of a 



FORMS OF IMPOTENCE 1 67 

perverse sexual feeling; for then there would be few' 
people in this world who were not, are not, or may 
not be affected by paresthesia of sexual sensation as 
thus defined. 

If the perverse sexual sensation is congenital, it is 
in most cases accompanied by particularly vehement 
or impetuous manifestations of the amorous desires. 
This abnormally increased sexual desire, which 
Krafft-Ebing terms hyperesthesis of the sexual sen- 
sation, is seldom a disease in the true sense of the 
word, and its explanation is, in my opinion, to be 
found rather in the circumstance or fact that abnor- 
mal sexual desires can be gratified only occasion- 
ally or with difficulty. Besides, the affected indi- 
vidual revolts, in proportion to his moral strength, 
against the satisfying of the ever-increasing lust — 
say, for murder or other lusts incomprehensible to 
men whose volition or desires are in a normal condi- 
tion. The individual is unable to control himself 
only when these perverse sexual sensations have 
reached the point when they must be called hyperes- 
thetic. Then a crime is committed. 

Persons thus affected procure satisfaction of their 
lusts by the most remarkable means. It is hardly 
possible to introduce order or a systematic classifica- 
tion into the sundry forms of this disease, because the 
longer we observe and investigate the more new 
forms present themselves. It might, however, be 
attempted to establish four groups of perverse sex- 
ual sensations, according as the satisfaction is looked 
for in perverse acts : 



1 68 SEXUAL IMPOTENCE 

i. On persons of the other sex; 

2. On persons of one's own sex; 

3. On animals; 

4. On inanimate objects. 

In the first group we should have to place first of 
all lust-murder and similar phenomena, as, for in- 
stance, different acts of cruelty to females. It is a 
fact long known that cruelty and voluptuousness are 
sometimes associates; a telling witness is the novel 
" Justine," by Marquis de Sade. Here the monster 
pretends even to pose as a type with his perverse 
lusts. It seems to me extravagant, however, when 
Krafft-Ebing speaks of voluptuous kissing approach- 
ing biting in a chapter made up of lust-murder and 
allied phenomena. It is only by individuals who 
are decidedly psychopathic that real cruelties are 
performed for satisfying sexual lusts, and the lust- 
murderers who use the knife and the dagger 
are all without exception suffering from mental 
aberration. 

Several years ago I watched a case of this na- 
ture. The mother of a poor, fourteen-year-old boy, 
B., noticed that the body of her son was covered with 
black and blue spots, particularly the arms, buttocks, 
and thighs. After an examination, the boy con- 
fessed that his fifteen-year-old friend, P., son of an 
aristocratic and rich family, had induced him by gifts 
of money to allow himself to be pinched. When the 
little tormented fellow found the pains too great he 
began to cry and scream, whereupon his torturer 
commenced striking him with his right hand while he 



FORMS Or IMPOTENCE 1 69 

moved his left quickly to and fro in the left pocket of 
his trousers. When the cruel boy was afterward 
brought under my notice, I learned that he suffered 
from epileptic fits (epileptics are frequently subject 
to perverse sexual sensations). He was, on the 
whole, a well-behaved, peaceable, and talented child, 
but occasionally very disobedient, headstrong, and 
passionate. I convinced myself besides that he was 
an onanist. When alone with me he confessed that 
torturing his friend, whom he liked personally, af- 
forded him a special delight, and that the ejaculation 
which he brought about at the same time was much 
more pleasurable than when caused by masturbation 
without his tormenting any one. The grandfather 
and an uncle on the mother's side died in an asylum ; 
the mother was a sufferer from hysterical attacks. 
The father was known as a high liver; two brothers 
and sisters died at a tender age of what the mother 
called "Fraisen" (convulsions). At that time I 
expressed the opinion that the boy, whom I watched 
for some time, would meet with a sad fate in spite 
of all the care and treatment that he was receiving. 

A good and well investigated example of a similarly 
predisposed child is the celebrated case of Jesse 
Pomeroy. 1 

The most common form of perverse sexual gratifi- 
cation is that which manifests itself in love for one's 
own sex. The men who love men and the women 
who love women, the "urnings" by birth, are proba- 
bly but few, but more common are the pederasts and 

• x Med. Record, June 20, 1903, p. 967. 



170 SEXUAL IMPOTENCE 

the priestesses of Lesbian love from necessity and 
lack of something better. (From numerous reports 
received recently, it seems, however, that Germany 
emulates the Near-Orient, and that urningism and 
bisexuality are very frequently observed there.) 
The impossibility of satisfying sexual desire in the 
natural way in educational institutions, convents, 
prisons, on board ship, etc., leads many persons to 
such perverse acts. More frequent than is generally 
thought is pederasty between husband and wife, to 
prevent unwelcome progeny. Some persons practise 
it with prostitutes in the hope of avoiding contagious 
diseases. 

This is the kind of perverse sexual sensation which, 
more than others, can be and is acquired by people 
who are not predisposed by inheritance, but who, in 
consequence of blunted senses for natural charms, 
sink step by step, and finally find pleasure in loath- 
some and disgusting acts. Impotence often leads 
men to this vice, and hence it is generally old people 
who are addicted to it. 

Percy 1 of Galesburg, Illinois, threw some light upon 
this phenomenon when he presented his paper of 
sexual perversion accompanying prostatic hyper- 
trophy, asserting truths that have been observed in 
a great many cases, but seldom or never properly 
explained. He believes, and I know he is right, 
that the old prostatic, who shows aberrant sexual 
activity, is in a large proportion of cases suffering 
from a psychosis rather than senile dementia, to 

1 Journ. Am. Med. A., July 2, 1910. 



FORMS OF IMPOTENCE 171 

which the symptoms are usually attributed. Under 
the influence of the irritation from his enlarged pros- 
tate, he may commit all forms of sexual crime, and 
after removal of his prostate his functional sexual 
aberration disappears and he remains cured. 

Percy emphasizes that this phase of the diseased 
prostate opens up the possibility of a more rational 
study of the pelvic environment of the prostate gland 
in the sexual perverts among men, old and young. 
Many old prostatics are in insane asylums, many of 
them are in the government and state soldiers' 
homes, as well as in the various county almshouses. 
The strain of sexual excesses from early life until old 
age, the intimate connection maintained between 
the prostate gland and the sympathetic and the 
cerebrospinal nerves, the unknown secretory function 
of the prostate gland along physiologic lines, these 
all make prominent the fact that with the hyper- 
trophied prostate can be had a class of symptoms 
referable to the sexual system, where the mental 
life of the sufferer carries him close to the border 
where insanity has its dominion, and which can be 
corrected by the aid of surgery. 

In the Near-Orient pederasty is very common. 
Even Moses had to decree capital punishment for 
those guilty of this crime. Some authors think it is 
frequent there because of the fact that in Oriental 
women the genitals relax at an early age and become 
rather capacious. 

If love for one's own sex has for its cause a congeni- 
tal perverse sexual sensation, the subject will usually 



172 SEXUAL IMPOTENCE 

show something peculiar in his character and appear- 
ance. His mode of thinking and of feeling is 
changed so as to correspond to that of the opposite 
sex. Most of these individuals whose perverted 
senses are due to inheritance betray their inclination 
by their conduct, often also by the garments they 
wear. The males have a liking for the occupations 
of females, and vice versa. 

Some authors, as Gley and Magnan, endeavored to 
explain this phenomenon by assuming the presence 
of the sexual glands of a male associated with the 
brain of a female. Whatever the explanation may be, 
it is a proved fact that the perverse sexual sensation 
of an urning is absolutely independent of the will, and 
that many such persons have gone through the most 
dreadful struggles, but could not escape their fate. 

Krafft-Ebing, basing his conclusions upon his ex- 
perience, contends against the assertion of Tarnov- 
sky, that a real urning — i.e., one afflicted with con- 
genital perversion of the sexual life — may, through 
education, be freed from his morbid sexual inclina- 
tion and led to a normal sexual life. Krafft-Ebing 
admits that a good education will act here in the 
same manner as in a man with normal feeling but 
sensual, and will enable the individual to strive 
toward mastering the impulse, avoiding pederasty, 
and counterbalancing the desire, but only so long as 
this perverse desire does not assert itself with abnor- 
mal strength. 

In his monograph on "Human Energy," Albert 
Abrams speaks of the present tendency to refer all 



FORMS OF IMPOTENCE 1 73 

phenomena to a sexual basis, and odd and even 
numbers can be regarded as the mathematical sexes. 

Abrams, based on his studies of human energy, 
conceives a normal predisposition to bisexuality 
which in the process of development changes to 
monosexuality. 

Homosexualists are found practically everywhere, 
and many of them, ignorant of their inversion, 
seek advice for psychic impotence. 

These inverts may be: 

1. Absolute, when their sexual object is always 
of the same sex ; 

2. Amphigenous, when their sexual object may 
belong to either sex ; 

3. Occasional, when recourse is had to homo- 
sexuality when normal sexual gratification is in- 
accessible (Brill). 

The diagnosis of homosexuality is often difficult. 
The homosexualist may show no hereditary taint 
nor any overt clinical anomaly in the mental or 
physical sphere. In other words, to all appear- 
ances, he may be like a normal individual and 
secondary sex characters may be absent. It may 
take months of painstaking psychanalysis before 
the inversion is discovered. 

Abrams says: "There are typical and atypical 
men, and sexual differentiation is never absolute. 
There is a permanent bisexual condition, however 
vestigial and rudimentary. Humans will event- 
ually be subjected to a biologico-physiological 
differentiation of polarities." 



174 SEXUAL IMPOTENCE 

The same writer, by aid of his visceral reflexes, 
contends that the homosexualist can be recognized 
at once by the polarity of his discharged energy. 

M. Rencurel 1 has observed on the island of Mada- 
gascar a distinct class of unsexed men, called Sarim- 
bavy, who have neither hetero- nor homo-sexual feel- 
ings. 

The third group of sufferers from perverse sexual 
sensation are the so-called Sodomites, people' who 
gratify their lusts with animals. Sodomy was part 
of the religious cult of several ancient nations, includ- 
ing the Egyptians. 

There are various causes which may lead a human 
being to sodomy. Generally it is weak-minded 
persons, cretins, imbeciles, or idiotic people who, in 
their sexual excitement, have intercourse with 
animals. This excitement may occur periodically. 
In exceptional cases, also, persons apparently 
psychically sound may, for want of something better, 
abuse an animal if the occasion is offered and if they 
feel sexually excited. Very seldom is it moral deg- 
radation that induces a man or a woman to seek an 
animal for the gratification of amorous desires, but 
frequently elderly unmarried women use dogs for 
various unsavory purposes. 

I had an opportunity to observe a case of sodomy. 
In a small provincial town a thirty-year-old man, an 
army officer, was caught in the act of gratifying his 
lust with a hen. One hen after another had perished 
in the house, and efforts were being made to discover 
the cause. When he was asked in court how it came 

1 La Semaine Medical, 1900, No. 48. 



FORMS OF IMPOTENCE 



175 



that he had turned into a cock, the defendant sug- 
gested that the smallness of his genitals made inter- 
course with women impossible. An examination 
proved the assertion to be well grounded. The indi- 
vidual was psychically normal. Unfortunately, I 
neglected at the time to make a searching examina- 
tion and to investigate the past history of the case, as 
the subject had no special interest for me at that date 

(1877). 

The fourth and last group of perverse sexual sensa- 
tion consists of those who satisfy their lusts on in- 
animate objects, and, of course, does not include the 
different kinds of onanism with manipulations on 
lifeless things. The observations in this direction 
are not always quite reliable. It may be mentioned 
merely that in most cases articles of women's toilette, 
such as linen, night-caps, shoes, etc., have occasion- 
ally the power to excite sexually and to satisfy indi- 
viduals of perverse sexual feelings, who are, as a 
rule, by inheritance predisposed to mental diseases. 
Krafft-Ebing 1 says, "In other cases the sexual de- 
sire is roused by the sight of a woman's underwear, 
and is satisfied by their manipulation." If the cen- 
ter of ejaculation is in a state of irritable weakness, 
the mere putting on of such clothes suffices; other- 
wise masturbation must lend its help. Again, some 
individuals have to tear these articles to pieces in 
order to cause ejaculation. 

Tarnovsky speaks of a psychopathic individual 
finding sexual gratification in the manipulation of 
peltry. Again, isolated cases have been observed 

1 Op. cit., p. 48. 



176 SEXUAL IMPOTENCE 

where statues were appealed to for sexual gratifica- 
tion. Very instructive are a number of cases reported 
by Albert Moll. 1 

Ghastly and horrible is the defilement of corpses, 
of which even as ancient an author as Herodotus has 
spoken. One cannot easily imagine that any person 
in sound mind could be capable of such an act. 

And now, at the conclusion of our discussion on the 
inherited and congenital forms of impotence, we have 
to mention some isolated causes of psychopathic con- 
ditions by which the sufferers may be rendered tem- 
porarily or permanently impotent, or at least sexually 
weak. In the first instance, idiots possess very 
feebly active sexual life, which is wanting entirely 
in idiocy of high grade. Sometimes the sexual in- 
stinct appears periodically, and then it is of a very 
violent character; the idiot, resembling then a wild 
beast, seizes without warning the nearest female, 
even though she be his own mother. 

Finally, for the sake of completeness, we should 
note that impotence and heightened sexual impulse 
accompany some mental diseases. 

NEURASTHENIC IMPOTENCE. 

Under this collective name we shall discuss all the 
forms of impotence dependent on a gradual degenera- 
tion of the sexual nerves and their centers. The 
present state of science does not disclose the charac- 
ter of this degeneration. 

Before Beard every symptom of general neurasthe- 

1 Untersuchungen iiber die Libido sexualis. Berlin, 1897. 



FORMS OF IMPOTENCE 1 77 

nia used to be named and described as a distinct dis- 
ease. In like manner the symptoms of neurasthenic 
impotence were described as special forms of disease 
and as special forms of impotence. People formerly 
spoke, and still do speak, of irritable weakness, psy- 
chical and relative impotence. Since the name 
"neurasthenia" has become so fashionable, and as 
the neuro-pathologists employ this collective name 
for forms of diseases that were hitherto designated 
by distinct names, we follow their example and de- 
scribe under the name of neurasthenic impotence all 
forms of sexual weakness the origin of which we can- 
not trace to any structural change in the organs of 
erection and secretion, or which cannot be ascribed 
to any distinct appearance of disease in the body or 
in the so-called psyche. 

A clear distinction between those forms of im- 
potence that arise merely from an affection of the 
nerves or nervous centers of the sexual apparatus and 
the other forms of impotence are of the greatest 
importance in the development of therapeutics. 

Beard's fame has disturbed the peace of mind of 
our authors. Every day new names were and are 
being invented and dished up for the already per- 
plexed practitioner. Every author has a new- 
fledged name for the old phenomena of disease, and 
our hopes that these new names would not live to 
an old age are being invariably realized. 

Impotence as a consequence of sexual neurasthe- 
nia either has its origin in a congenital predisposition 
or else is acquired. We have already spoken of the 
congenital forms, and shall now give our attention 

12 



178 SEXUAL IMPOTENCE 

mainly to the acquired forms of sexual neurasthenia. 

Neurasthenic impotence is less often caused by dis- 
ease than by bad management of the natural sexual 
power — i.e., by excess in venery, either for the 
time being or habitually, by onanism, and occasion- 
ally by abstinence of longer or shorter duration. 

Every man's virility has its limits, and these must 
be respected, for daily experience teaches us that im- 
potence is most frequently caused by abuse. At the 
same time we must insist that the expression "ex- 
cess in venery' ' has been misapplied without limit by 
most of our authors. To form a correct opinion in 
individual cases, and to distinguish between sexual 
excess and normal though frequent use, one must, 
first of all, possess personal experience in the matter, 
and must have observed the history of the sexual 
life in a great number of cases. Even the most ex- 
tensive experience will not, in all cases, enable us 
to decide whether or not excess has taken place. 
Lallemand says, 1 "I call abuse every abnormal use 
of anything. Concerning the generative organs, I 
understand abuse to be every irregular, premature, or 
other action which cannot result in the propagation of 
the race. There are no doubt many connecting 
links between these abuses and sexual excesses." 

Lallemand, therefore, distinguishes between an 
abuse of the sexual power and excess in venery, and 
we shall retain this very sound distinction, as it will 
afford a special clearness to the subject under discus- 
sion. This is the more desirable because the two ex- 
pressions thus separated to define very different 

1 Des pertes seminales, tome i, p. 315. 



FORMS OF IMPOTENCE 179 

things have usually been confounded and made 
the object of the most diverse and remarkable 
views. 

Suppose an individual to have enjoyed coition 
without exceeding his natural power and without 
having had either the desire or the possibility for 
propagation, then, strictly speaking, he may be said 
to have committed an abuse of his sexual power, but 
certainly not an excess. I believe that a medical man 
need not concern himself about the abuse of virility 
so long as there is no excess connected with it. Let 
each be his own judge, and if any one requires 
a judge, let him address himself to his confessor. 

If we choose to call an abuse of the sexual power 
every act of coitus that has not been undertaken 
with the possibility or even the intention of propaga- 
tion, then abuse of virility will be carried on as long 
as there is a normal and virile man in the world, and 
we need not feel alarmed about it. If coition, how- 
ever, were to be accomplished only when a woman is 
to be impregnated, then most men would become 
impotent from continence, and a great many would 
become insane. My conviction is that the physician 
is concerned with excesses in venery only because 
they alone injure the body. 

Lallemand 1 defines excess in venery in these few 
words: "L 'usage pousse au-dela des besoins reels," 
(usage carried beyond real wants). This definition, 
however, admits of more than one explanation, 
since the meaning "real wants" is indefinite. Is 
a man actually to wait until the sexual instinct 
1 Op. cit., p. 489. 



x 8o SEXUAL IMPOTENCE 

awakens without any action of his own? If so, 
many men engaged in serious occupation would 
never come to sexual gratification. The pleasures of 
love would then hardly be reserved for any one ex- 
cept the man of leisure and the idler. 

I think a better definition would be this : Excess is 
coition for which an effort is required. Coitus easily 
performed and for which the individual does not re- 
quire long preparation can never be called excess, 
even if no "real want" is to be satisfied. 

For the explanation of the specially injurious ef- 
fects of sexual intercourse for which more or less 
effort is required, we must look to those cases where 
copulation or even excess is attempted or accom- 
plished with uncongenial, nay, repulsive, mates. It 
is simply incomprehensible that Deslandes and Hun- 
ter could say that copulation with a woman, not 
rousing any special feeling in the man, is not so hurt- 
ful as when passionate love accompanies the act. 
Every day's experience convinces us of the contrary. 
Men who, for some reason or other, give too frequent 
proofs of very ardent love to a woman really dis- 
liked, suffer comparatively much more from it than 
those who give to a beloved or, at least, sympathetic 
being proofs of their love by still more frequent 
embraces. 

It must also be observed here that those forms of 
impotence that arise from sexual excess, and particu- 
larly from too frequent coition, are mostly of a 
slighter and transient character, and comparatively 
easy to cure. Only after protracted abuse may 
those conditions occur that lead to real and some- 



FORMS OF IMPOTENCE l8l 

times an incurable form, the so-called paralytic 
impotence. 

Man, as an animal gifted with reason, has reached 
special excellence in various spheres. In many a 
province of knowledge and art he has left marks of 
his inventive genius. In most things it took him 
thousands of years to pry into and lay open the 
secrets of nature. Some fields are still left fallow by 
his investigating power ; he has never felt a desire to 
turn his attention toward them. He possesses, how- 
ever, quite perfect knowledge of the means of abuse of 
his sexual power, and he knows how to commit all 
kinds of sexual excesses. This knowledge he ac- 
quired at so early a date that even the very oldest of 
monuments of human culture tell of it as of something 
that had existed since the most remote antiquity. 
Modern culture, in spite of all the lamentations of 
tiresome, old or hypocritical moralists, is not to be 
blamed for the almost universal abuse of the sexual 
power. This has been transmitted to us, like many 
other detrimental inheritances, by preceding ages, 
and our time suffers under it neither more nor less 
than it does from many other bad qualities, perverse 
notions, and unsuitable institutions handed down to 
us by our ancestors. Moreover, we find among un- 
cultivated nations the most remarkable and cunningly 
invented sexual perversities. The charm-rings in 
use among some of our arrant rakes are mere toys in 
comparison with the so-called "ampallang" 1 of a few 
savage tribes. The only merit that can be claimed 

1 Mantegazza, Gli amori degli uomini. Milano, 1868, vol. i, 
p. 108. 



1 82 SEXUAL IMPOTENCE 

by our present time is that we have laid bare and 
shown in its true light the weakness of man in com- 
mitting excesses in venery, and that we have exerted 
ourselves in discovering remedies for checking this 
devastating evil. 

I am convinced that the united efforts of all the 
better elements of our society will succeed in preserv- 
ing the nobler part of it from excesses in sexual grati- 
fication ; and, though I do not expect to see an end of 
the excesses in venery, I hope to see onanism cur- 
tailed in the number of its victims, though it may be 
only in the better circles of society. This latter ex- 
pression, "better circles," I wish, however, not to be 
understood in the sense commonly attached to it 
nowadays. 

In general, and leaving out of question the per- 
verse manifestations of amorous desire of which we 
have already spoken, it is found that excesses in sex- 
ual enjoyment may take place in two distinct ways. 
There is excess in copulation, and that of self- abuse 
or onanism. 

It is hard to determine at which point of natural 
coition normal indulgence ends and abuse com- 
mences; and to fix on a certain frequency of sexual 
intercourse seems merely ridiculous. Regarding the 
frequency of copulation to be allowed we shall not 
easily agree; for, as there was a Martin Luther who 
allowed two conjugal acts per week, we have also an 
Acton who will allow one per week, and a queen of 
Aragon who demanded six per day. The Talmud 
prescribes one act of coitus per day for a man in com- 
fortable circumstances, who is strong and has no 



FORMS OF IMPOTENCE 1 83 

heavy work to perform. It allows two per week for 
a mechanic, and only one per week for scholars and 
laborers. 

In the consideration of this question there must 
be kept prominently in view the great and various 
differences in individuals. Just as the digestive 
power differs in different men, and the act of thinking 
is not of the same rapidity in all, so also is the sexual 
capacity of very different grades. The appetite of 
one person may be perfectly satisfied by a small 
quantity of food, anything beyond that causing dis- 
comfort or nausea. Another person digests much 
larger quantities of food without inconvenience. A 
third, after coitus, may be disabled for a fortnight, 
while a fourth, after coition repeated several times at 
short intervals, can hardly await the next happy 
hour of love. I do not think I am in error in making 
the assertion that there is no excess so long as no 
unusual effort is required, no special means is made 
use of for rousing sexual passion, and no feeling of 
fatigue or faintness is experienced, regardless of the 
number of copulations, even if repeated at short 
intervals. 

In the determination of sexual excess, a despicable, 
narrow-minded way of moralizing has come down 
from author to author, these gentlemen seeming to 
have forgotten that they are of the medical and not 
of the clerical staff. Such hypocritical sermonizing 
will certainly convert no one. As long as there are 
lovers there will be excesses in the estimation of the 
authors, but not resented by nature. Nature pun- 
ishes only such as act contrary to her laws by em- 



1 84 SEXUAL IMPOTENCE 

ploying various means to rouse desires and to irritate 
the strained nerves to immoderate activity. 

Since virility is not of the same degree in all indi- 
viduals, the limit between normal use and excess in 
them must also be different. Without regard to age 
or the state of health, the disposition at the time be- 
ing is of extraordinary influence. That which was 
moderate indulgence ten years ago may be excessive 
to-day; and even what might have been accom- 
plished easily and without fatigue a few days or a 
few weeks ago may be hurtful now. So also what 
may have seemed quite normal with one woman may 
have to be considered as a decided excess if com- 
mitted with another woman. 

Inquiring into the reasons that induce a man to 
commit sexual excesses, we cannot, after what has 
been said above, accuse age, amativeness, tempera- 
ment, etc., as Lallemand does; for such manifesta- 
tions of the sexual instinct as are produced by youth, 
temperament, or sensuousness cannot be called ex- 
cesses. The inducements to excess in venery are 
only few; in the order of their frequency they are: 
masculine vanity, love, sensual women, different 
conditions of irritability of the sexual organs, and 
hyperesthesia of the sexual centra, which may pass 
into maniacal conditions and become a veritable 
satyriasis with priapismus. 

Masculine vanity is the commonest cause of sexual 
excesses, as Lallemand 1 has already observed. In 
wedlock and out of wedlock the man feels the desire 
to impress the woman with his power. He starts 

1 Op. cit., p. 614. 



FORMS OF IMPOTENCE 1 85 

from a principle that is correct in itself, but he very 
often carries it out in a faulty manner. Over-exer- 
tion in sexual matters seldom impresses the woman 
favorably, and inevitably leads to humiliation; and 
besides, the descent from the pedestal of a hero often 
leads to dissatisfaction in marriage, and may induce 
the wife to seek elsewhere that which she has learned 
to like and which her husband can afford her no longer. 

Love may sometimes give occasion to excess. The 
desire to unite with the object of love as often as pos- 
sible may overtax the sexual organs. Love is decid- 
edly a powerful stimulus, but, like all stimuli, it loses 
its power in time. Love may have lost its stimulus, 
but may still live if the cause lies only in the giving 
way of virility. When love, however, has lost its 
stimulating power, although the man has retained 
his vigor, then love has simply ceased to be love. 

Voluptuous women may now and then be the 
cause of sexual excess, but it must be said that in 
general over-sensual women are the exception, and 
novels and anecdotes know more about them than 
does actual life. Almost without exception, woman 
grows unduly sensual only in commerce with sensual 
men; but if once she is so, then woe to the man 
whom she holds under her sway, if he has not the 
courage to wish her good-by in time. 

Occasionally skin-diseases about the genitals 
cause too frequent erections by external irritation. 
If we except gonorrhea and its sequelae, quite as 
unfrequently there may occur irritation of the veru- 
montanum or in its vicinity, causing untimely erec- 
tions and thus provoking excesses. 



1 86 SEXUAL IMPOTENCE 

Some persons have naturally the disposition to 
love always and much; they do not feel happy un- 
less they are in love, and when they are they commit 
so-called excesses, which in reality are not to be so 
regarded, but which should rather be considered as 
manifestations of their sexual power. Indeed, we 
see that such fortunately disposed natures receive no 
harm whatever from these apparent love-extrava- 
gances, as they endure mental and physical exertions 
exceedingly well. Such natures are oftener met 
with in southern countries than in northern, oftener 
belonging to the better educated classes than to the 
uncultivated. They are mostly of a temperament 
easily roused, generally superficial, and in common 
life are called light-minded people, but sometimes 
deserve a better name, since they accept life as it is. 
As a rule, puberty shows itself in such persons very 
early, long before it appears in other individuals of 
the same nationality. Mantegazza 1 says, "To pre- 
cocious puberty correspond luxury, polygamy, and 
libertinage." The coincidence of early puberty and 
excesses in southern nations, may find its explana- 
tion in the fact that persons entering upon the pos- 
session of their sexual power before they possess 
full responsibility are more apt to commit sexual 
extravagances. 

Again, abundance of power will be sure to lead to 
excesses, as authors understand them; but these, in 
my opinion, are not excesses so long as the right pro- 
portion with the force is maintained. Decidedly 
enviable are those so fortunately gifted by nature, 

1 Gli amori degli uomini, vol. ii, p. 233. 



FORMS OF IMPOTENCE 1 87 

whom we might call with Mantegazza 1 "grandi- 
amatori" (great lovers), and of whom he says, "The 
great lovers are frequently weary, but in their weari- 
ness there is not a shadow of ennui." 

Excesses in venery are generally committed by 
men of a noble character, who subordinate hygienic 
considerations to the pleasure of sharing the highest 
delight with a beloved creature. Hence it is gener- 
ally genial natures endowed with artistic talents that 
worship sensual pleasures and often fall a victim to 
them; while egotistical and mean natures calculate 
in numbers and are stopped in love's intoxication by 
the thought, "That might hurt me." It is, how- 
ever, very strange that those individuals that take 
so little care for the preservation of their virility are 
often the very ones who keep it until an advanced 
age, while those who have always husbanded their 
power so economically often lose it prematurely. 
The force of habit plays here an important r61e. 
Some descend from much to little, and others from 
little to naught. 

I beg leave here to advance an opinion which is in 
opposition to the views of most authors — viz., a 
strong and healthy man may, by means of reasona- 
bly active gymnastics of his sexual power, increase it 
considerably without damaging his health, since a 
vigorous metabolism is capable of rapidly replacing 
all such losses. I should hesitate to express this 
opinion in a book subject to the chance of being read 
and misunderstood by laymen; but, in a work writ- 
ten for medical men exclusively, I feel it my duty to 

x Pisiologia dell'amore. Milano, 1882, p. 383. 



1 88 SEXUAL IMPOTENCE 

state the bare facts unadorned as experience has 
shown them to me, and thereby obtain the result, 
perhaps, that some doubt may introduce itself 
into the realm of common petty ideas of narrow 
minds. 

A gland that has seldom been excited to ordinary, 
and never to energetic activity, will never yield the 
same quantity of secretion as one that is never over- 
taxed, but is roused frequently and vigorously. Ex- 
actly the same may be said of the muscles of the ap- 
paratus in question, which, by reasonable use, may 
be strengthened and rendered capable of performing 
their functions. The glands and muscles active in 
sexual intercourse, all of which are secreting or at 
work through the influence of the nerves in action, 
are subject to the same laws as the nerves them- 
selves, and will consequently be assisted in their se- 
cretion and strengthened in their activity by moder- 
ate and even stronger irritation, though they would 
be weakened by too strong an irritation. 

It is certain that the nervous system is strength- 
ened by every inducement to action as long as the 
action required is within the limits of performance 
without effort. Too much, however, is here more 
damaging than too little, and the happy mean is to 
be followed. 

Too little irritation is apt to render the nerves and 
their centers inert in reaction and weak in functional 
power; thus, the genital glands which they innervate 
will be made indolent in secretion and the muscles of 
erection weakened and stunted. Again, too much 
irritation affects badly the co-operating nerve-appa- 



FORMS OF IMPOTENCE 1 89 

ratus, and causes first a state of excitation and then 
of relaxation. This is the reason why men who are 
habitually excessive in venery are for a time spe- 
cially powerful, for the sexual nerves are in a state of 
excitement; but this condition gradually changes 
into a state of weakness, which, in its turn, passes 
over into a state of paralysis if rest does not inter- 
vene in time. " Lasting immoderate irritation of the 
nerve, without a time of rest sufficient for recupera- 
tion, gives rise to lassitude at first, and then leads to 
diminution of the excitability by exhaustion of the 
nerve; and yet the nerves are possessed of extraor- 
dinary endurance with respect to the most various 
irritations." 1 

Decrease of the sexual power is for one who com- 
mits excesses in venery a sign, given by a sometimes 
kind nature, that it is time to retreat. Unfortu- 
nately, this sign, though noticed by most offenders, 
it is true, is wrongly interpreted, and may even 
cause impatience or anger. A struggle against na- 
ture begins ; moral, physical, and even medicamental 
excitants are brought into service, but even these 
subsidiary forces leave the individual in the lurch, as 
the combat is an unequal one, and impotence is the 
result. 

Now, instead of looking for help, the impotent 
man gives way to the general belief that there is no 
herb growing for impotence. The physician often 
supports this belief by sending the unfortunate pa- 
tient away with a few well-meant phrases of solace, 

1 Landois, Lehrbuch der Physiologie. Wien und Leipzig 
1893, p. 673. 



190 SEXUAL IMPOTENCE 

instead of proceeding first to a correct diagnosis and 
then to the determination of the appropriate treat- 
ment. Thus, then, the patient is generally either 
driven into the clutches of the advertising quack- 
sharks, where the damage done to his purse is the 
least of the risks to run; or he is left to himself; 
recourse is had to new and stronger excitants; he 
torments himself to bring about coition; these 
fruitless efforts aggravate the evil; they dull the 
nerves and their centers more and more, until, 
finally, they exhaust them, so that paralytic impo- 
tence results. 

In order to comprehend the pernicious effect of 
habitual excesses in venery, we must first of all con- 
sider more closely the after-effect of the sexual 
act. According to most authors, man, after copula- 
tion, is in a state of exhaustion, the duration of which 
varies in the opinion of these authors. Now, gener- 
ally speaking, this is not so. A robust man who is in 
possession of his full sexual power is, after coition, 
not exhausted or depressed at all. He keeps gener- 
ally perfectly still, because the action of the heart 
and of the lungs has been accelerated and must now 
be moderated, and because he still holds the object 
of his love in his arms and ruminates upon the past 
happiness. Those individuals who feel exhausted 
after copulation had better not commence at all, and 
the authors who uphold the idea may possibly give 
expression to their own experience. With a man 
perfectly vigorous sexually the Latin phrase "Laete 
venire Venus, tristis abire solet," applies only to the 
same extent as in the case of a gourmand who 



FORMS OF IMPOTENCE I9I 

enjoys a good appetite, and thus regrets, after a meal, 
that it is not to commence. The discovery made by 
Beard, that the pernicious consequences of coition 
often do not show themselves until the third day, must 
be characterized as at least peculiar. This discovery 
our American neuropathologist claims to have made 
on a patient who was unquestionably neuropathic, 
and, moreover, suffering from spermatorrhea. A 
man who feels the effects of copulation three days 
afterward ought to be forbidden sexual intercourse. 

Now, although I deny that coition must of neces- 
sity be followed by a state of exhaustion, yet I must 
grant that coition implies or necessitates the spend- 
ing of a certain amount of force. In the first instance 
it means a bodily exertion; secondly, the work per- 
formed by the nerves and their centers is considera- 
ble; and, thirdly, on the part of the male the loss of 
substance must be taken into- account. It is cer- 
tainly not the bodily exertion that causes the perni- 
cious consequences of immo derate copulation, for we 
know that all bodily exertion is rather beneficial to 
the health of man. Is it the undue effort of the 
nervous system, or is it the excessively great loss of 
substance? Certainly neither the one nor the other 
alone, but both combined, with the co-operation of 
other influences which we shall be in a better position 
to explain when we know more about the secrets of 
internal secretion. 

To prove that the excessive loss of sperm causes 
the bad effects of sexual excesses, a comparison of 
these effects on the two sexes has often been made. It 
has been asserted that women suffer more rarely 



192 SEXUAL IMPOTENCE 

than men from the evil consequences of sexual ex- 
cess. This assertion is not in accordance with daily 
experience, which teaches us that sexual excesses 
have on women a more serious and more lasting ef- 
fect than on men. We need only to observe very 
young married couples. The recollection of every 
physician will show him the pale and fatigued face 
of the wife beside the comparatively fresh, though 
somewhat emaciated, face of her husband. 

Attention must, however, be called to the fact that 
women very soon accustom themselves to sexual ex- 
ertion, and then even excesses are more easily en- 
dured by them. Besides, if the woman feels a dis- 
inclination for a man, she can, without participating 
in the act, simply endure it. If disinclination on the 
part of the man can cause in him relative impotence, 
disinclination experienced by the woman may pro- 
duce a kind of frigidity, so that while giving herself 
up to the act she can remain perfectly indifferent. 
Here we have, then, the key to the assertion of some 
men who declare women in general to be sexually 
greedy; while others — especially scholars, for whom 
the ladies have often no liking — declare them cold 
and insensible. 

The loss of substance certainly plays a role of some 
importance, and it is not only the circumstances 
preceding and accompanying the ejaculation, and 
certain processes going on in the nervous system, 1 
which cause the evil effects of sexual excesses. This 

1 Curschmann, Die functionellen Storungen der mannlichen 
Genitalien. Handbuch der speciellen Pathologie und Thera- 
pie von Ziemssen, Band ix., Halfte 2, p. 476. 



FORMS OF IMPOTENCE 1 93 

may be understood when we consider that evil con- 
sequences of a greater magnitude follow the loss of 
sperm from spermatorrhea than from sexual ex- 
cesses. In some cases of spermatorrhea of a high 
degree the loss of semen is unattended with con- 
sciousness, and we can hardly imagine any accom- 
panying influence that could primarily affect the 
nervous system. 

Paget 1 thinks that the morbid condition in the 
nervous system, and more especially in the spinal 
cord, caused by excessive coition is analogous to the 
condition which is observed in muscles after ex- 
cessive efforts. The comparison between muscle- 
atrophy and paraplegia might be very instructive if 
sexual excesses ever caused paraplegia. 

In this comparison by Paget of muscle-action and 
nerve-action I consider only the following observa- 
tion correct, in which he says, " I cannot explain to 
myself why excessive coition infallibly causes loss of 
sexual vigor with certain persons, while the same ex- 
cess causes in other persons no manner of disturb- 
ance. But the same different effects are observed in 
respect to muscle-effort, and remain also without 
explanation. A given amount of muscle-exertion 
that exhausts one individual and leads to muscle- 
atrophy develops the power in another, and in- 
creases the capacity and vital energy of the muscles 
at work." 

What are the real consequences of immoderate 
coition? As far as my knowledge reaches, there is 

1 Acton, Fonctions et desordres des organes de la g6n6ration, 
P- 237- 
13 



194 SEXUAL IMPOTENCE 

only one really serious effect, but that brings in its 
train a series of other evils : it is sexual impotence. 

No one doubts that excesses in venery cause impo- 
tence. Those who have not denied themselves the 
enjoyments of life know that after such excesses 
there occurs a time during which desires lie dormant. 
With weaker natures such a time follows sometimes 
after very few excesses; even after a single night of 
revelling, there ensues a longer or shorter period 
when coition would be an impossibility. This condi- 
tion cannot be called impotence, for it is physiologi- 
cal, similar to the state of fatigue, and is caused by 
the spending of the provision of sperm and the ex- 
haustion of the sexual nerves and their centers. 
With sexually weak men this state lasts longer than 
with stronger ones. It will last longer after re- 
peated excesses, and these pauses growing ever 
longer pass sooner or later into a permanent inabil- 
ity, which we justly call impotence. These pauses 
are certainly a wise provision of nature ; they are, in 
a measure, bars placed in front of the impetuosity of 
youth. Without these bars there would be many 
more impotent persons than there are. 

After sexual excesses the spinal cord is no doubt in 
a state of hyperemia. Hence the state of irritation 
in the centers of erection that continues after the ex- 
cess, and the fatigue of the overtaxed nerve-sub- 
stance which is plainly seen after the cessation of the 
hyperemia. After many such states of lassitude, 
which may pass away more or less rapidly, there en- 
sues a state of exhaustion which may be permanent. 
This constitutes impotence. Impotence following 



FORMS OF IMPOTENCE 



195 



sexual excesses is in the great majority of cases a 
state of exhaustion of the nerves and nerve-centers 
concerned — a kind of sexual neurasthenia of differ- 
ent grades. 

In the main, excesses in venery cause only sexual 
neurasthenia; while onanism causes, besides sexual 
neurasthenia, derangement of the organs of secre- 
tion, and especially of those of ejaculation. From 
this arise primary morbid pollutions, which finally 
produce impotence. The same is true of continence, 
but in rare cases only. 

Neurasthenia sexualis arising from sexual ex- 
cesses shows, like every other form of neurasthenia, 
quite peculiar phenomena, and its symptomatology 
resembles that of general neurasthenia in many 
points. As already stated, there are to be seen signs 
of exhaustion of different grades. Sometimes the 
desires of the patient are in marked contrast with his 
force. At times positive satyriasis may be observed 
in completely impotent men. Such individuals prac- 
tise mental and actual onanism, as they are no longer 
capable of performing the sexual acts so ardently 
wished for. 

Again, the sexual apparatus may still be compara- 
tively apt in function, but the subject is nevertheless 
impotent because of a sexual frigidity which is not 
an unusual consequence of sexual excesses. The 
feeling of satiety which is observable after nearly 
every sexual excess, but which generally disappears 
rapidly, becomes permanent in some cases, and the 
individual, who still has erections now and then, is 
nevertheless impotent, as he is apathetic toward 



196 SEXUAL IMPOTENCE 

the female sex. This state, it is true, is commonly 
observed only in persons who have never had a well- 
developed sexual instinct, and who, in spite of this, 
allowed themselves to be incited to excesses. The 
same state may, however, appear in persons of a 
strongly developed sexual impulse, who have com- 
mitted repeated excesses with persons whose physi- 
cal qualities were not worth such an effort. Such 
frigidity is particularly noticed after manifestations 
of power performed with a view to pecuniary gain 
and in husbands who sometimes perform their con- 
jugal duties for years, and conscientiously, but with 
reluctance. 

Another form of impotence is noticed in the track 
of excesses in venery continued for years, in which 
the sexual organs may continue to be capable of 
function. After years of excesses there arises a state 
of satiety for ordinary sexual pleasures, a torpor 
of the sexual emotions for normal and natural satis- 
faction. A perverse sexual sensation develops itself 
quite gradually. The patient is incapable of per- 
forming the sexual act in a natural manner, but can 
still indulge in cunilingus, fellatio, pederasty or other 
wayward acts to satisfy his perverse lusts. This 
form of impotence in consequence of sexual excesses 
is oftenest observed in old men, the majority of whom 
have some psychical affection. All the perverse ac- 
tions of sick and also of insane persons are merely an 
extraordinary augmentation of normal phenomena, 
emotions, and acts arising from psychological and 
physiological origin ; and similarly we can trace, in 
the forms of perverse feeling, a highly abnormal 



FORMS OF IMPOTENCE 197 

exaggeration of phenomena observed in healthy 
persons. 

It is generally known, though not so generally ad- 
mitted, that the original taste in sexual matters un- 
dergoes manifold changes with increasing age and 
after numerous sexual enjoyments. As there is a 
great difference in the individuals, it is impossible to 
establish a general rule or law, and I shall therefore 
attempt only to represent the process in the 
manner in which it generally presents itself for 
observation. 

In the first place, we must entirely exclude the 
early years of ardent desires that come before com- 
pletely developed sexual maturity. These are the 
years of sexual blockheadedness and awkwardness; 
the individual is without taste, and not at all partic- 
ular in the choice of altars on which to make his sacri- 
fices to Venus, although he dreams of ideals. When, 
however, that sexual bulimia, as we may call it, is 
over, taste appears, and the individual grows partic- 
ular within the limits of his taste. This taste is good 
or bad in the opinion of his fellow-men, but, judged 
from his own standpoint, it is always good. The 
taste remains then generally settled during the years 
of the greatest virile power; but when riper man- 
hood approaches it begins to deteriorate. The in- 
dividual grows less and less particular, and will carry 
on commerce with persons he would formerly have 
rejected with contempt. This corruption of taste is 
the reason why elderly gentlemen often associate, for 
the time being, with slovenly and unattractive ser- 
vant-girls. Closer examination will prove the error 



198 SEXUAL IMPOTENCE 

of the generally accepted opinion that elderly gentle- 
men are dainty in their choice, and that only the 
want of a better chance can make them less par- 
ticular. Of course, due consideration is to be paid 
to the role played in this respect by education, the 
different conditions of wealth, rank, and other 
circumstances. 

The abnormal exaggeration of this physiological 
degradation, as I would call it, in the sexual taste, is 
often the origin of perverse sexual sensation. The 
class of individuals who have thus become perverse 
comprises many of those who, after a long, honest, 
and exemplary existence, come, in their old age, into 
conflict with the law, as pederasts, exhibitionists, 
or ravishers. 

In a few isolated cases, and especially with sexu- 
ally weak individuals, continued excesses lead to 
paralytic impotence, as already stated. This is 
equivalent to complete paralysis of the sexual nerves 
and their centers — a condition which certainly oc- 
curs very seldom in young persons. 

Besides the states already described, excessive 
venery causes transient feebleness in the entire body 
and disturbances in the functions of single organs. 
After a real excess in venery the individual feels 
weary and exhausted, may be nervously agitated for 
a time, and may be visited by vertigo and fainting 
fits. However, all these symptoms generally vanish 
after a few hours' undisturbed sleep following a 
strengthening meal. The individual will experience 
no further consequences. 

I never saw or heard of ejaculations mixed with 



FORMS OF IMPOTENCE 1 99 

blood ; although Lausac 1 asserted that the causes of 
it may be urethritis, prostatitis, epididymitis, also 
sexual excesses, or prolonged continence. I believe, 
however, that this is probably of exceedingly rare 
occurrence, may be observed in cases where the 
seminal vesicles, the prostatic gland, or the coli- 
culus seminalis are in a state of acute or chronic 
infectious inflammation, and will hardly ever ap- 
pear in normal individuals. We know now that 
gonorrhea cannot arise from protracted coitus or 
sexual excesses, as Lallemand 2 seemed to believe. 
Nor can I believe that sexual excesses can cause 
degeneration, suppuration, or induration of the 
cerebellum. 3 

Some individuals committing frequent excesses in 
venery, if they are strong, accustom their nature to 
these excesses after a time. Such wanton persons 
may commit great excesses almost with impunity for 
a long time. They consider themselves heroes in 
sexual matters; but, nevertheless, they steadily lose 
flesh in spite of an appetite that may be quite excel- 
lent. Sometimes it is noticed that sexual excesses 
seem to favor the development of obesity. I have 
known a man, thirty-two years old, who was con- 
tinually losing weight during continence and a 
state of good health, while he gained in weight 
when he was doing his utmost sexually. As the 
conditions leading to obesity are now better under- 
stood, we can easily explain why this should be so. 

1 Untersuchungen liber die Hamatospermie. Med.-chir. 
Rundschau. Wien, 1888, Heft 3, p. 95. 

2 Des pertes seminales. Paris, 1836, tome i, p. 586. 

3 Black, On the Functional Diseases of the Urinary and Re- 
productive Organs. London, 1875, P- II2 - 



200 SEXUAL IMPOTENCE 

Sooner or later the sexual power is sure to diminish 
noticeably after sexual excesses, even with individuals 
of great resisting power, and temporary impotence 
will then for a time prevent further excesses. This 
dallying with one's sexual power I have observed 
frequently, and have received many reports of the 
same kind from my patients. 

I never saw the fearful consequences of excesses as 
they are described in books. I never saw a single 
case of frequent pollutions or spermatorrhea caused 
by excess in venery. Considering that I have 
observed a great number of such wanton persons, 
and a still greater number of patients suffering from 
spermatorrhea, I may be justified in the assertion 
that immoderate coition without onanism cannot 
cause spermatorrhea. Among Oriental nations, where 
polygamy is the rule, and occasions for excesses are 
constantly presented, premature impotence is often 
noticed, but spermatorrhea very seldom. Abnormal 
pollutions and spermatorrhea arise now and again 
in the train of impotence, but never directly after 
excesses in venery, however long these may have been 
practised. This is the chief difference between the 
effects of onanism and those of excessive coition. 
Some modern authors are of a different opinion, but 
it strikes me as peculiarly characteristic that Lowen- 
feld 1 reports the histories of thirteen cases of neuro- 
ses, etc., in consequence of abstinence, and not one 
to support his assertion that excesses in venery cause 
"at least pollutiones nimiae." Furthermore, it is 
only a contradiction when this kind of pollution is 

1 Op. cit., p. 65. 



FORMS OF IMPOTENCE 201 

regarded as a physiological sign of health, 1 and also 
as a pathological consequence of sexual excesses. 

The consequence of excess in venery is always and 
without exception impotence, this impotence putting 
a stop to further excess. 

It is difficult to obtain a clear idea of the manner of 
action of the pernicious effects of continued sexual 
excesses, because we are denied the possibility of 
watching the pathological changes caused by these 
excesses. Virility enfeebled by habitual excess does 
not make itself felt by any kind of trouble in the sex- 
ual organs, and sometimes, though no change in 
them is visible, the individual is impotent. 

Although the rest of the body may be quite nor- 
mal in its functions, we see that some persons suffer- 
ing from sexual debility lose weight while others 
become pinguid; the individual tissues in all cases 
showing more or less flaccidity. This degeneration 
of the forces, this general sinking, is due to the 
changes in the general metabolism, and to a certain 
extent also to the injurious effect produced on the 
mind by the consciousness of impotence. The 
changes in the general metabolism are easy to be 
explained on the basis of our present knowledge of 
the internal secretion of the various glands. 

The condition of sexual nerves in cases of para- 
lytic impotence can be attributed only to the con- 
sumption of their nerve-power; whatever that may 
mean. While the question has scarcely been 
studied at all, and lies in great darkness before us, 
we can only say, Continued excesses in venery lead 
sooner or later to impotence, with a rapidity varying in 
1 Ibidem, p. 165. 



202 SEXUAL IMPOTENCE 

proportion with individual differences; and impotence 
brings very often in its train other unpleasant conse- 
quences. If some authors state that there are men 
who commit excesses in venery with impunity, we 
must remember that what these men have com- 
mitted were not excesses in the true sense of the 
word. 

It is amusing to read the statement that some 
cases have been noticed where single excesses in ven- 
ery have caused death. No doubt long-continued 
sexual excesses may cause temporary disturbances 
in the functions of other bodily organs, but perma- 
nent derangement certainly can occur only in weak 
and sickly individuals, since the sexual organs invar- 
iably refuse obedience in proper time. 

The assumption that sexual excesses may directly 
cause atrophy of the testicles, for example, is cer- 
tainly erroneous, since impotence is always primary; 
while atrophy of the testicles is only secondary in 
consequence of impotence. 

It used to be the custom to impute everything to 
sexual excess: a death whose cause was not clearly 
discernible was attributed to sexual excesses; if 
some one became insane, sexual excesses were 
blamed for it. Even in case the father and mother 
had been insane, inheritance had nothing to do with 
it. If a man died suddenly in an ill-famed house, 
sexual excesses were accused, and one forgot that the 
man had quite as good a chance of dying suddenly in 
his conjugal bed, though he rarely may have made 
the proper use of his matrimonial rights. If any one 
should wish to convince himself of the exaggeration 
that was usual in these matters until a few years ago, 



FORMS OF IMPOTENCE 203 

has only to take up Bourgois' book, 1 for instance, 
where he can read literally, "Dissolute persons are so 
frequently subject to spinal diseases that the special 
name of dorsal consumption or phthisis, tabes dorsalis, 
has been given to them when they originate from sex- 
ual excesses." Dr. J. A. Spalding, of Portland, 
Maine, goes even further, and relates the history of a 
group of four cases of optic atrophy following sexual 
excess. All four subjects gradually lost useful vision 
in spite of treatment, though they did not become 
totally blind. As no other mortal ever had the 
chance to observe such consequences of sexual ex- 
cesses, and Dr. Spalding, on the contrary, found four 
such phenomenal cases, we have to look toward the 
Portland climate or imagination for an explanation. 

Recently Moczutkowski tried to resurrect the old 
idea that tabes dorsalis is caused by excesses in 
sexualibus. We can only agree with Mobius 2 who 
did not show very much respect for Moczutkowski' s 
queer way of reasoning and his jumping to false 
conclusions on the basis of falser premises. 

In no other disease has cause so frequently been 
mistaken for effect, and vice versa. Authors too 
often ascribe many pathological states to sexual ex- 
cess, without noticing that these morbid states, to- 
gether with their supposed cause, have a common 
and deeper origin in an inherited pathological predis- 
position. Thus, then, the effect was mistaken for 
the cause. 

1 Les passions dans leur rapports avec la sante et les maladies. 
Paris, 1877, p. 144. 

2 Neuere Beobachtungen iiber die Tabes. Schmidt's Jahrbucher, 
1902, Heft 1, p. 6. 



204 SEXUAL IMPOTENCE 

Generally speaking, real excess in venery seldom 
occurs, and is not often the cause of impotence or of 
a general physical degeneration. In case extraneous 
circumstances do not prevent an individual from 
accomplishing his own ruin by sexual indulgence, 
nature, as a rule, will refuse him the means for con- 
tinuing his excesses. Xot all women will consent to 
excesses ; again, the individual, if somewhat energetic, 
may restrain himself from further excesses. 

As an illustration of the frequent "post hoc ergo 
propter hoc, reasoning the following clinical history: 

Before the great San Francisco fire, caused by a 
very interesting though insignificant earthquake, a 
man of thirty-one (if my memory is correct, because 
the records were burned) consulted me for absolute 
lack of erectile power, and gave following history: 
Married when about twenty-eight years old, he loved 
his wife, and, as he said, overindulged in sexual inter- 
course, though I think he did not more so than most 
newly married people do. In the seventh week of 
his married life, one morning after an intense coitus 
the erection did not abate, the priapismus lasted 
nearly a week, and the man never had another erec- 
tion during the following two years. This patient ad- 
mitted syphilitic infection to have taken place three 
years before marriage and showed traces of former 
luetic lesions. Lohnstein 1 reports a similar case. 

While I have my suspicions that the priapism in 
my case was due to some pathological changes of or 
near the centers of erection, I am not ready to claim 
that syphilis is always at the bottom of priapism. 

1 Blum, Sexual Impotency in the Male, The Amer. Jour, of Urol- 
ogy, February, 19 13, p. 103. 



FORMS OF IMPOTENCE 205 

Terrier and Dujarier 1 report on forty-eight cases 
of priapism collected by them, and find that pro- 
longed priapism frequently follows excessive sexual 
intercourse. Many times it develops without appar- 
ent cause and suddenly. Some times the real 
affection is preceded by recurring attacks of transi- 
tory priapism. Of the forty-eight patients thirty- 
one recovered, of these five died subsequently of 
leukemia. Two of the patients died during the 
attack. Sexual impotence was the usual conse- 
quence. Local inflammatory processes, tuberculous 
and others, neurasthenic conditions, traumatic le- 
sions mainly of the spine and the perineum are most 
frequently to be blamed, while syphilis was the 
cause only in one of the forty-eight cases. 

We may safely assert that sexual excesses as such 
hardly ever cause priapism us. 

We shall meet with altogether different conditions 
when we make excessive onanism or masturbation 
the subject of our discussion. If onanism 2 causes 
degradation of the physical force and impotence 
much more frequently than excesses in venery, we 
find the explanation in this difference of all the 
conditions. 

It is only an exception when excesses in venery 
can be practised before the individual has become 
pubescent, for he generally lacks the means and occa- 
sion therefor; onanism, on the contrary, may be 
practised by an undeveloped child, as, unfortunately, 

1 Revue de chirurgie, May 10, 1907. 

2 Common usage in all countries has established the meaning of 
the word "onanism" without any regard to what Onan, according 
to the Bible, really did. 



206 SEXUAL IMPOTENCE 

is frequently the case. Of course, every sexual ex- 
cess committed by an individual before puberty is 
ever so much more far-reaching in its consequences. 

Nature is seldom able to hinder the onanist in his 
destructive work until it is too late. The onanist 
wants no erection : he can without it bring about or- 
gasm and ejaculation. The onanist need not wait 
for time of leisure or for a special place or occasion. 
He can satisfy his desire in bed under the warm 
covers, almost under the eyes of his parents and 
teachers, in the closet, in any dark corner. Some 
have acquired such dexterity that they can ever add 
new injury' to the weakened sexual organs, which are 
almost continuously in a state of irritation, by clever 
manipulations of the penis by the hand introduced 
into the pocket of the trousers. This can be done at 
school, at church, at the theatre, at balls and other 
entertainments, or during a walk in the street or a 
ride in a carriage. 

The recovery from this condition is more difficult 
to accomplish, and the ability to desist from further 
injuring the sexual power is more difficult to acquire, 
in this case than in the case of excessive venery. The 
individual is not able to avoid seizing the opportunity 
to practise his vice. It often takes a long time for 
the onanist to get a clear understanding of the evil 
consequences of his actions; but when he does dis- 
cover his error, a fearful struggle arises between the 
pernicious, almost overpowering habit and the en- 
feebled juvenile, who may be a mere child. This 
struggle is so hard and dreadful that even a vigorous 
and energetic man might succumb. 

There is yet a weighty circumstance that renders 



FORMS OF IMPOTENCE 207 

excesses in onanism far more fatal than excesses in 
venery. The one who commits excesses in venery is 
ever enamored, feels seldom any remorse about the 
excess he has committed, but is rather inclined to 
look upon it as a triumph of his irresistibleness and 
power. He is satisfied with himself, and draws im- 
measurable joy from the inexhaustible treasury of 
love. He is most of the time happy, and his joyous 
mood contributes largely toward the preservation of 
a healthy condition of his body. The reverse of this 
is the case with the onanist : he is always in conflict 
and exceedingly dissatisfied with himself; he is 
ashamed of his doings, and regrets to commit what is 
commonly called a " vice." Hence the onanist is ill- 
humored and melancholic, this state of the mind hav- 
ing an influence which almost without exception pro- 
duces an injurious effect on the functions of nearly 
all the bodily organs. 

This one harmful factor in onanism was usually 
under-estimated and by some authors even ridiculed, 
but is now, the influence of the mind over the body 
being better studied, also better understood. 

Finally, it must be stated that it is not at all set- 
tled whether coition and masturbation are equiva- 
lent acts. I doubt it very much, because I know 
that with individuals accustomed to excess in ven- 
ery the commission of a single act of onanism leaves 
them in a weaker and more dejected state than a 
great excess in copulation. I think that, after all, 
the circumstances preceding and accompanying ejac- 
ulation, and, most of all, certain processes in the 
nervous system, must be of more consequence in 



208 SEXUAL IMPOTENCE 

onanism than in copulation, and that these "circum- 
stances and processes ' ' require a greater effort to be 
brought about by onanism than by coition, and con- 
sequently produce greater fatigue. Hummel 1 thinks 
that the climax of excitation in masturbation is 
higher than in the normal intercourse, and for this 
reason more of an insult to the " cerebro-spinal 
centers." 

Every medical man who thinks about this matter 
must ask himself whether those authors are right 
who call onanism a vice. I do not think they are: 
for if we take into consideration the circumstances 
under which one falls a prey to onanism, and, more- 
over, the almost insurmountable difficulties en- 
countered in resisting or overcoming the bad habit, 
we unquestionably must come to the conclusion that 
onanism should with more justice be called a disease. 
In the same manner in which one may fall sick with- 
out any fault of his, he may fall into the grasp of 
onanism and be unable to tear himself away even 
with the greatest effort. 

The most common form of onanism consists in 
moving with manu propria the prepuce backward 
and forward over the glans until ejaculation is 
obtained. Sometimes the onanist produces friction 
of the prepuce against another object, as, for in- 
stance by lying on his stomach and rubbing against 
that upon which he rests, thus causing the prepuce 
to move over the glans ; less frequently there is mu- 
tual onanism practised between two men. This 

1 Nervous and Mental Effects of Masturbation. N. Orleans 
Med. and Surg. Journal, April, 1909. 



FORMS OF IMPOTENCE 209 

kind of onanism occurs most frequently among per- 
sons affected with perverse sexual feelings, but who 
have not yet sunk to pederasty. Still less fre- 
quently there is mutual onanism between man and 
woman; yet it occurs often enough, and seems to 
become a regular expedient in matrimony in some 
countries, whereby the increase of the family is 
avoided. Lingua et labia are then often used in the 
place of the hands. Thus we see that Freeman's 1 
definition: "Masturbation is the acquiring of all the 
sensations of sexual intercourse, including the orgasm 
without the aid of a second person," does not cover 
the subject. 

Onanism as a manner of satisfying the sexual in- 
stinct is very widely spread. It is practised by al- 
most every young man when he becomes pubescent, 
so that one might be tempted to look upon onanism 
as a physiological act; and this so much the more 
when we realize how eagerly monkeys and other ani- 
mals practise it. 

Onanism is not without its vindicators; only they 
have not the courage to speak aloud and publicly in 
behalf of their belief. In a small circle of pupils I 
once heard a very popular professor say that onan- 
ism moderately practised has its advantages, partic- 
ularly for students, as money and valuable time are 
saved, all unpleasant connections and obligations 
are avoided, no one is made unhappy, and there is 
no danger of contagious diseases. If considered 
from a low and egotistic standpoint, these reasons 

1 Maurice Freeman: Some Features of Masturbation. Am. 
Journ. of Dermatology, Apr., 191 1. 

14 



210 SEXUAL IMPOTENCE 

might be correct, if only the onanist were capable of 
keeping within moderate limits; but it is this ex- 
cessive onanism that renders it so particularly hurt- 
ful. The onanist's resolutions of restraint may be 
compared to the " serments d'ivrogne." Just as the 
drunkard, sitting with the last of the number of 
glasses that he vowed should not be exceeded, con- 
tinues to allow himself just one more, " always the 
last," so the onanist bargains with himself, and his 
"last time" becomes centuple, in spite of his vows, 
oaths, and promises. 

Although we have really to deal with the bare 
facts only, we feel interested in the causes of this 
universal practise of onanism, because, while obtain- 
ing a knowledge of the cause, we may get a knowl- 
edge of the remedy. 

There is no doubt that onanism is of very old stand- 
ing, surely as old as the human race. Over the 
whole extent of human history there is no lack of 
statements, or at least hints, about onanism. He- 
brews, Greeks, Romans, all were acquainted with it. 
It may be quite true that in olden times onanism 
was not so common, but civilization cannot be ac- 
countable for the difference; for in those times the 
young people did not lead sedentary lives; it was 
easier for them to procure natural sexual gratifica- 
tion, if they were not already pederasts. Pederasty, 
however, always goes side by side with onanism. 
Again, the intercourse with venal women was not 
dangerous, because there was no syphilis in those 
times. 

If onanism has not already become a habit, it is 



FORMS OF IMPOTENCE 211 

out of the question so long as the sexual instinct can 
be satisfied in the only natural way, in the arms of a 
responsive woman. This is, besides, the manner 
more in accordance with feelings of love; it is the 
more pleasant, the nobler act. When, however, this 
mode is denied, then with virile men erections occur, 
and from the temptation of feeling and fumbling 
about the genitals there is no great distance to mas- 
turbation. The present social regulations cause 
ever-increasing difficulties in the obtaining of a wife, 
and we should not be surprised to learn that onanism 
is really much more common at the present time 
than during any part of antiquity. Onanism is 
probably not practised by the monkey when living 
in liberty where he can go after his mate; nor by 
the bull nor the stallion that has enough of cows or 
mares brought to him; nor with the dog not led 
with a line by his master. Apes and other animals 
fall into onanism only when proper mates are not 
obtainable. 

There are many writers who assert that the cause 
of the wider and wider spreading of onanism is to be 
found in the ever-increasing corruption of morals, or, 
as some like to consider, identical with enlighten- 
ment. We will grant that onanism has been "ever 
spreading," though there is no proof of this, but we 
must repel the reproach laid at the door of modern 
culture or civilization. Modern culture has nothing 
to do with our bad social conditions and crazy views 
derived from medieval times which are the chief 
causes of onanism. These conditions and views came 
down to us from the time of the greatest religious 



212 SEXUAL IMPOTENCE 

intensity; and they remain in force, not because of 
our modern culture, but in spite of it. We can only 
hope that when this culture becomes common prop- 
erty it will free the world from these fetters that hin- 
der free action, and then onanism will be shown its 
proper place. Certainly it cannot be denied that the 
present mode of education of our children offers 
many moments favorable to onanism; but this very 
mode, too, is an inheritance from the dark ages. 

Children learn onanism mostly through seduction, 
and, as a rule, one child learns it from another. A 
single so-called black sheep often suffices to corrupt 
all the others in a family, institute, school, etc., 
whereby the frequency of onanism in boys' and girls' 
institutes finds an easy explanation. The younger a 
child is, the easier it is to allure it, even those who 
at first resist seduction finding later on a taste for it. 
It occurs, though seldom, that coarse, uneducated 
bad adults, even teachers, find a pleasure in mislead- 
ing immature children to onanism. In the literature 
of the subject we read of cases quite incredible. 
Thus, there are nurses and nursery-maids who under- 
stand how to quiet screaming children by playing 
with and sucking the child's genitals. It is to be 
remarked that the little screamer is easily and quickly 
silenced, but thereby a state of irritation in the sex- 
ual organs is. caused, and the child induced to pull 
and play with them, and finally to practise real 
onanism. This is the more injurious the younger 
and weaker the child is. 

Rarely, unwise parents, in their anxiety for the 
child, clothe their warnings in such awkward language 
that it draws the child's attention to sexual matters. 



FORMS OF IMPOTENCE 213 

I regret to be obliged here to add that occasionally 
the study of certain subjects may lead to onanism, and, 
unfortunately, it is, strange to say, principally the 
instruction in a subject that is generally thought to 
further morality. In the sentences and passages to 
be memorized words are used which quite evidently 
have reference to sexual matters. Immature chil- 
dren are served with little stories of the most piquant 
contents, which are for them the first hints of sexual 
things. Dull children think no more about them, 
but sprightly and intellectual children will ponder 
over these legends. Dried-up old pedagogues are 
not aware of the kind of thoughts that present them- 
selves to the child when meditating on certain stories. 
Then, again, we have in our high-schools the Latin 
and Greek classics with their often vulgar and blunt 
language. It is well known how eagerly and assidu- 
ously the passages of an erotic tendency are read and 
the greatest linguistic difficulties overcome, even if 
such passages are skipped by the professors. 

Withal, however, I do not mean to say that a 
youth should be brought up in ignorance of all sexual 
things. I do think that, by all means, a child 
has the right to be exempted from obscene ideas as 
long as he is sexually unripe and his nature does not 
assert itself. However, when puberty has arrived, 
and has announced its presence by unmistakable 
signs, then I think the youth should be told all the 
truth, without allowing him to be excited by piquant 
reading. Youth may find that piquant which leaves 
a man of mature age perfectly indifferent. 

What are we to say or to think of a medical man 
advising mothers to endeavor to accustom the pre- 



214 SEXUAL IMPOTENCE 

puce of their boys to remain behind the corona glan- 
dis? 1 As this can be accomplished only by moving 
the prepuce repeatedly back over the glans, such 
mothers would, in plain words, masturbate their sons. 

Bad example is the most frequent cause of the 
spreading of onanism, and causes the greatest in- 
jury, because it brings under the sway of onanism 
quite immature children who up to that time did not 
feel the least movement of sexual desires. If an in- 
dividual is not made acquainted with onanism by 
comrades, books, or in any other manner, he will en- 
ter the age of puberty without any erotic thought, 
and is what is commonly termed " perfectly inno- 
cent.' ' Notwithstanding this innocence, he may, in 
one moment, be overtaken by onanism. Sometimes 
violent erections cause him to touch the genitals with 
his hands, and thus he learns onanism involuntarily 
in some measure. 

Certain movements, performed for some other 
purpose, may induce onanism. I have a vivid recol- 
lection of the history of a youth in whom I was quite 
specially interested, and who involuntarily com- 
mitted an act of onanism. He was an industrious 
student, sixteen years old. During his studies he 
would take the most comfortable positions, and thus, 
lying one day on his stomach over three chairs, being 
lost in thought over his reading, he swayed his body 
to and fro, without noticing the erection. To his 
great surprise he experienced a most pleasant sensa- 
tion in his genitals, quite new to him, but at the same 
time he felt a strange moisture. It was sperm, 

1 A. Theod. Stamm, Dr. med., Dr. phil., Die Verhutung der 
geschlechtlichen Ansteckung. Zurich, 1886, p. 63. 



FORMS OF IMPOTENCE 215 

which he first took for urine. By such ways onan- 
ism may be induced in quite immature individuals, 
or individuals who have scarcely attained puberty. 
The incident at first is agreeable; its dangers are 
either unknown or the subjects are not willing to be- 
lieve in any. Youths, however, who are well aware 
that the evil habit injures them, have seldom the 
courage to rid themselves of it, and finally the bad 
consequences make themselves felt. 

We have now seen that the principal cause of this 
general spreading of onanism is innate in human 
nature itself, and is most commonly seduction. If, 
then, we speak of further causes of this disease, we 
shall understand thereby rather the occasions that 
help in the development of the germ. They do not 
cause onanism, properly speaking, but rather its im- 
moderate practice. 

The leader in these causes of onanism is the seden- 
tary mode of life to which our youth is generally con- 
demned — the want of outdoor exercise, the curse of 
the present customary mode of education. We 
must admit, however, that conditions are gradually 
being improved, principally in the United States. 

Habitual and even occasional constipation, at the 
bottom of so many pathological conditions, is un- 
doubtedly and frequently causing conditions in- 
citing to onanism. 

Flogging on the bare back or buttocks is apt to in- 
cite to premature activity the sexual organs, or, 
rather, the nerves which lead from the center of erec- 
tion through the spinal cord. This alone ought to 
be reason enough to induce us to abrogate as much 
as possible the brutal and absolutely unnecessary 



21 6 SEXUAL IMPOTENCE 

whipping of children. On some future occasion we 
shall show that such blows applied on the back and 
buttocks constitute a brutally empiric aphrodisiac. 

Then, too, we have lascivious reading and pictures 
which, heating the imagination, for the time being 
incite the sexual instinct in the highest degree, and 
must be the cause of many excesses in onanism. 
Theaters, balls, and other entertainments where 
young men come in direct or indirect contact with 
the female sex are rather effective preventives against 
immoderate onanism, in spite of the demonstrations 
of all the misanthropic or thoughtless persons who 
never see anything beyond the sphere of their rooms. 

I must raise my voice against those numerous au- 
thors who denounce riding on horseback as a cause of 
onanism. Riding, if done properly, like every bodily 
exercise, is not conducive to onanism, and whoever 
asserts differently gives a proof of his want of knowl- 
edge on the subject. Lallemand was the first to 
invent the story of the evil influences of horseback 
riding, and while modern authors seize every oppor- 
tunity to ridicule his views, they also stick to most 
of his antiquated mistakes. 

As determining causes of excess in onanism I must 
denounce idleness and loitering about, which occa- 
sionally become habits even with very assiduous 
youths; also going to bed too early and arising too 
late, especially lying in bed awake in the morning. 
Again, stimulating foods and drinks may prove to be 
determining causes for excesses in onanism. 

Another powerful cause in the propagation of onan- 
ism is the temporary or permanent impossibility of 



FORMS OF IMPOTENCE 217 

procuring a suitable and ardently coveted mate. 
The concupiscent desire increases, and finally even 
an energetic man of character may succumb. Again, 
uncleanliness may cause an accumulation of a sebace- 
ous mass between the prepuce and the glans, induc- 
ing continual itching, and thus the hands will be in- 
duced to manipulate the member, this possibly end- 
ing in onanism. 

As other causes of onanism may be mentioned 
stone in the bladder, various kinds of irritation about 
the promontory and the neck of the bladder, and 
certain cutaneous diseases, and especially phimosis 
with and without balanitis. Oxyuris worms also, 
by setting up an itching or irritation about the geni- 
tals, may cause onanism. Since Lallemand, however, 
too much stress has been laid on the frequency of 
these causes of onanism. 

' Some authors blame the working of sewing-ma- 
chines for causing onanism. The possibility of this 
cannot be denied, but, as Dr. Decaisne 1 says, a 
good deal of willingness is necessary. 

In the last instance we shall mention too tight 
garments as a cause of onanism. These may, by 
means of friction, lead indirectly to onanism, but 
only if the genitals are already in a state of irritation. 

In some exceedingly rare cases an inherited neuro- 
psychopathic predisposition may in very young 
children, cause premature awakening of the sexual 
instinct. The inevitable result will be onanism. 

The consequences of onanism never tarry long 
in showing themselves. Since, in most cases, unde- 

1 Fournier, De l'Onanisme. Paris, 1885, p. 67. 



2l8 SEXUAL IMPOTENCE 

veloped individuals are given to excess in onanism, 
the whole organism soon suffers from the excitement 
and the continual loss of sperm. These stimulations 
are too frequent and too violent for the undeveloped 
nervous system. The change of substance in the 
body is rapid enough, so that recuperation from 
the frequent loss of substance would not cause much 
disturbance in the system if the individual were not 
in great need of all his force and all the energy of 
his metabolism for his growth and further develop- 
ment. Hence we see that delicate and sickly indi- 
viduals suffer under excess in onanism a great deal 
more than strong and healthy ones. 

First anemia is produced, under the influence of 
which the digestive activity suffers, and, conse- 
quently, the whole body. Again, the shock resulting 
from the practice of onanism enervates the whole 
system, and, less frequently, causes in the nervous 
system a state of excitability. The nervous system 
has but little power of resistance, and the shock is re- 
peated very frequently. 

Many forms of neurasthenia have their origin in 
onanism. With young children onanism may even 
cause far more profound disturbances of the nervous 
system. I have seen a boy nine years old suffering 
from epileptiform attacks arising from onanism only; 
the attacks ceased upon the application of an ingeni- 
ously arranged bandage. I doubt, however, that 
onanism can cause real and permanent epilepsy. 
The effect of onanism upon the nervous system is 
specially pernicious in cases where children begin 
onanism before there is any sperm. Here there can 



FORMS OF IMPOTENCE 219 

be no question of loss of substance. The time of 
production of sperm is in such cases considerably- 
accelerated . 

The assertion that onanism causes tabes dorsalis 
is certainly an extravagant fancy. To attempt to 
prove such an assertion by stating that of one hun- 
dred and nine cases of tabes, ninety-seven of the pa- 
tients confessed to onanism, as Fournier 1 claimed is a 
mistake. Fournier's report proves only that of one 
hundred and nine people at least ninety-seven have 
practised onanism at some time, and that most of 
them are ever ready to look upon any disorder in the 
conditions of health as a result of this wretched 
habit. The consequences of onanism are serious 
enough; there is no necessity to add anything from 
sheer fancy. 

As to the special effect of excesses in onanism, we 
state, in the first place, that the sensibility of the sex- 
ual organs is heightened, and, in time, to an excessive 
degree. Very soon a hyperesthetic form of sexual 
neurasthenia develops, which, by itself, can cause 
impotence. 

Edward Martin 2 says, 'Masturbation unques- 
tionably determines at first acute hyperesthesia and 
hypermia of the prostatic urethra. This is ulti- 
mately followed by a chronic congestion and by al- 
most complete anesthesia of the same region. " I, 
for my part, never was able to observe chronic con- 
gestion and any degree of anesthesia together, but 

1 Op. cit., p. 125. 

2 Impotence and Sterility. Hare, System of Practical 
Therapeutics, vol. iii, p. 662. 



220 SEXUAL IMPOTENCE 

always found that, whenever there was congestion, 
hyperesthesia never was missing. Observations 
made recently with the aid of Goldsmith's endoscope 
only confirm this view. Hypertrophy, however, is 
frequently accompanied by anesthesia. 

Besides, excess in onanism, in a much higher de- 
gree than excess in venery, is a cause of a gradually 
increasing frigidity and aversion for the other sex. 
This aversion is at the same time a cause and a con- 
sequence of impotence. The patient is impotent 
because he feels an aversion for the female sex, and 
he is averse to the female sex because he feels himself 
impotent. In the midst of the absurd and crazy so- 
cial institutions of our time such people often assume 
the role of heroes of virtue, and are set as examples 
for others who have the misfortune (?) to be some- 
what virile. Again, excesses in onanism are more 
frequently the cause of perverted sexual sensation 
than are excesses in venery. 

The augmented sensibility of the sexual organs is 
the chief cause of the involuntary emissions during 
sleep which invariably follow excesses in onanism; 
these pollutions are finally followed by spermator- 
rhea, and have impotence as their consequence. A 
relaxation of the entire sexual apparatus occurs 
simultaneously with the over-excitement of the sex- 
ual nerves and their centers. In this enfeeblement, 
as a matter of course, the muscular apparatus of the 
ductus ejaculatorii participates, whereby a further 
condition arises tending toward excessive pollutions 
and spermatorrhea. Of course, enfeeblement of the 
whole organism and weakening of the sexual organs 



FORMS OF IMPOTENCE 221 

go hand in hand and keep nearly apace with each 
other. Sometimes the rest of the body still presents 
a quite satisfactory state, while there is already 
great disturbance in the functions of the sexual or- 
gans. This is the case chiefly with onanists of ma- 
ture age who are affected by hereditary low sexual 
power of little resistance. 

Finally, it is asserted that excessive onanism may 
cause atrophy of the testicles Such cases being de- 
scribed by Curling and Albert, 1 I will only point to 
their extraordinary scarcity, without giving expres- 
sion to my doubts. It is more probable that atrophy 
of the testicles did not occur until onanism had 
caused impotence. 

The most frequent and therefore best observed dis- 
eases caused by excess in onanism are immoderate 
pollutions and consequent spermatorrhea. Know- 
ing, as we do, that onanism is an evil of long stand- 
ing, we shall not be surprised if Moses knew of the 
pollutions. 2 According to his regulations, a man 
who had an effusion of semen was unclean for a whole 
day, and likewise the woman who may have been 
lying with him. 

Too frequent pollutions are the most common 
causes of impotence, and we may, therefore, say with 
some authority that onanism is the cause of impo- 
tence in the great majority of cases. Of one hundred 
persons suffering from pollutions there were at least 

1 Hofmann, Lehrbuch der gerichtlichen Medicin. Wien, 
1881, p. 63. 

2 Trusen, Darstellung der biblischen Krankheiten. Posen, 
1843, p. 9. 



222 SEXUAL IMPOTENCE 

ninety-nine addicted to excessive onanism, so that 
all other causes together hardly ever come under 
consideration. 

If a healthy, robust person, in full possession of his 
sexual power, does not in any wise satisfy his sexual 
wants, and if the glands preparing the sperm do not 
cease their action, an ever-increasing quantity of 
semen collects in them, causing a very great tension, 
particularly in the seminal vessels, and this leads to 
so-called physiological pollutions. 

Now the question arises, How frequent may these 
be before they should be called excessive? Some 
authors have even pretended to fix the limits within 
which pollutions may be repeated. This is, however, 
not admissible, since the sexual organs do not act 
with the same energy with all persons, and the num- 
ber of pollutions during a time of abstinence cannot 
be the same with individuals who were accustomed 
to daily intercourse, and with others who indulged 
only once a week. Therefore we have to consider as 
decisive not numbers but the circumstances that ac- 
company and follow the involuntary loss of semen. 
Besides, the great divergence in the frequency con- 
sidered normal by different authors is sufficient proof 
of their unreliability. 

A pollution may be called normal under the follow- 
ing conditions: it must, first of all, occur during 
sleep — i.e., during absence of consciousness and will- 
power; it must be accompanied by a vigorous erec- 
tion, erotic dreams, and by the natural sensual grati- 
fication ; it must cause a sensation of well feeling and 
relief, but not of faintness, depression, headache, or 



FORMS OF IMPOTENCE 223 

other similar troubles. If any one of these condi- 
tions is missing, the pollution must be considered 
morbid. 

We shall, with Curschmann, 1 classify morbid pol- 
lutions as follows: 

I. Morbid pollutions occurring during sleep. 

a. The pollutions are more frequent than is normal 
according to the peculiarities of the individual and 
the natural state of his semen secretion. The ac- 
companying phenomena are unchanged, but the pa- 
tient feels afterward faint, low-spirited, and is some- 
times troubled with headache, etc. 

b. The number of pollutions reaches such a height 
that they appear for this reason alone as pathological. 
The pollutions may occur every night, or even more 
than once in one night. Moreover, they may occur 
sometimes directly after coitus, and even in a bed 
shared with a woman. The accompanying phenom- 
ena still resemble those of normal pollutions, but 
the consequent pathological sensations are still 
more marked than in group a. 

c. There is very great frequency, but an absence 
of the phenomena accompanying normal pollutions, 
such as erection, erotic dreams, and voluptuous sen- 
sations. The ejaculated semen is very small in 
quantity, and in quality a thin liquid. In this group 
of morbid pollutions the psychical shock and the loss 
of substance are both insignificant, and yet the con- 
sequent phenomena are very grave. 

1 Die functionellen Storungen der mannlichen Genitalien. 
Ziemssen's Handbuch der speciellen Pathologie und Therapie, 
Band ix, Halfte 2, p. 467. 



224 SEXUAL IMPOTENCE 

II. Morbid pollutions in the waking state. 

a. The pollutions take place while the individual 
is awake, in consequence of trifling mechanical irrita- 
tion, such as friction by a tight garment, riding on 
horseback or in some conveyance. 

b. The so-called diurnal pollutions happen even 
under the impress of psychical influence. Finally, 
as the last form: 

c. The patient loses semen during micturition or 
defecation. 

In reference to the above and similar classifica- 
tions it must be remarked, however, that loss of 
semen during the waking state occurs frequently 
without coming under the head of an aggravated 
state of morbid pollutions. Spermatorrhea, partic- 
ularly following an obstinate gonorrhea, is to be 
considered a case of this kind. 

Most authors distinguish between pollutions and 
spermatorrhea, but their definitions of spermator- 
rhea are quite varying, the limit between pollution 
and spermatorrhea being fixed differently by differ- 
ent authors. Since, however, these distinctions are 
of no value in therapeutics, we shall, with Cursch- 
mann, give the name of spermatorrhea to those forms 
of pollutions that are of a high degree and take place 
during consciousness. Roubaud 1 gave the name 
pollutions to those losses of semen which are accom- 
panied by venereal orgasm, and spermatorrhea to 
those that are unaccompanied by sexual desire or 
erection or voluptuous sensation. Older authors 
have described by the name spermatorrhea a state 

x Op. cit., p. 327. 



FORMS OF IMPOTENCE 225 

in which sperm is said to flow continuously. Since 
we have no trustworthy report of any such case, we 
cannot have any faith in the above statement, al- 
though we admit the possibility that, if the organs of 
ejaculation have ceased to act, the sperm may flow 
off as it is secreted. We must lay special stress on 
the fact that although morbid pollutions occur very 
frequently, yet those of a high degree which deserve 
the name of spermatorrhea are exceedingly rare. 

To Lallemand is due the merit of having directed 
the attention of the medical profession to this dis- 
ease of morbid pollutions, which till then had been 
well-nigh neglected, and we can gladly overlook the 
exaggerations to which he may easily have been mis- 
led. Modern authors profit by his investigations, 
and yet ridicule the man who has written his name 
indelibly on modern pathology and therapeutics of 
pathological sperm effusion. This keen observer has 
studied and described the nature of this disease so 
precisely that the authors of to-day can only ex- 
press in other terms what has already been said by 
Lallemand. If they deviate essentially from his 
path, they are generally in the wrong. His method 
of cauterizing was up to a few years ago the alpha 
and omega of the local treatment of this disease, al- 
though variously modified and named. It would be 
an injustice if we were to blame him for seeing in 
every one of his patients an individual affected with 
spermatorrhea, and for having an unlimited confi- 
dence in his method of cauterizing. Some of our 
celebrated specialists have similar weaknesses. 

And now it seems as if we were again called to go 
15 



226 SEXUAL IMPOTENCE 

back to Lallemand. An authority like Wossidlo 1 
comes to the conclusion that lesions of the verumon- 
tanum are often found in patients suffering with 
pathological pollutions, prostatorrhea, spermator- 
rhea, impotence, insufficient erections, or premature 
ejaculation. Wossidlo made the experience that in 
many cases, all treatment fails until local measures 
are applied through the endoscope directly to the 
verumontanum ; a proceeding which I kept on 
advocating since 1889. The results obtained are 
almost in direct proportion to the improved methods 
and instruments. 

Lallemand unquestionably deserves the credit of 
having proved that excessive loss of sperm is a dis- 
ease or, at least, a symptom of disease, which can and 
must be treated. Of what use to a man who suffers 
from weakening pollutions is a physician who, fol- 
lowing the example of renowned clinicians, laughs at 
him and sends him home with some insignificant and 
useless prescription? You should witness the de- 
spair that takes hold of such an unfortunate being 
when he sees what little importance the doctor at- 
taches to his condition, which, he feels, is sapping all 
his physical and mental strength. 

It is a poor consolation to say that only the minor- 
ity of the patients asking for advice about losses of 
sperm are really suffering from pathological pollu- 
tions. Such assertions coming from competent men 2 
are apt to make the physician careless or indif- 
ferent in the treatment of this disease, and to induce 

1 Zeitschrift fur Urologie, 1908, No. 3, p. 243. 

2 Curschmann, op. cit., p. 495. 



FORMS OF IMPOTENCE 227 

him to consider these pitiable persons as imaginary 
sufferers. I am, on the contrary, of the opinion that 
such patients, with but few exceptions, are in great 
need of medical help for these excessive pollutions, 
which may not kill them at once, but which cause an 
irreparable loss of general and sexual force. The 
sooner such patients consult the physician, the more 
wisely they act, because chronic evils are more 
difficult to treat ; and it is a pity that because physi- 
cians are taught to look with lofty disdain upon 
such matters, considering them to be trifles, the 
bulk of the sufferers who are compelled to differ in 
opinion, are driven into the welcoming arms of the 
advertising charlatans. 

I agree absolutely with Eulenburg's 1 opinion. 
He says, " I believe that a pollution is no more to be 
considered as normal than a cough or vomiting, and 
that even the so-called normal pollutions originate 
really in some unusual and exceptional irritation, 
which may be comparatively light, but which acts 
upon the center of ejaculation." 

It has already been pointed out that onanism is 
nearly the only cause of morbid pollutions. Cases, 
however, may be met with in which morbid pollu- 
tions are also caused by acute inflammatory condi- 
tions in the urethra, such as gonorrhea, inflamma- 
tion, and tumors of the seminal vesicles, chronic in- 
flammation of the neck of the bladder and of the 
pars prostatica urethrse. Phimosis, various diseases 
of the rectum, such as piles, fissures, eczema, and 
other cutaneous eruptions of the rectum and its 

1 Sexuale Neuropathie t Leipzig, 1895, p. 55. 



228 SEXUAL IMPOTENCE 

vicinity, are, since Lallemand's time, accused of 
being the cause of morbid pollutions. Such causes 
as these are seldom observed and taken into account, 
although the accumulation of smegma in conse- 
quence of phimosis, the presence of oxyuris vermicu- 
laris in the rectum, or other diseases producing irri- 
tation in or about the genitals, may easily cause 
erections and also nocturnal emissions. We have 
already seen that such diseases are causes of onanism, 
and, indirectly, of pollutions. 

It is a disputed question whether obstipation and 
difficult defecation are capable of causing pollutions 
and spermatorrhea. It seems very plausible that 
the pressure of hard and voluminous scybala and 
forced contraction of the rectum may force out some 
seminal liquid. There is no doubt that masses of 
feces which have collected in the rectum can cause 
erections and nocturnal emissions in consequence of 
the pressure and incitement they may exercise on the 
sexual organs. It is more than doubtful, however, 
that with a healthy man the difficulty in connection 
with defecation is able to press sperm out of the sem- 
inal vessels. We would rather agree with Cursch- 
mann's 1 view, which he expresses thus: "Theo- 
retically considered, the opinion made reference to — 
viz., pressure from the rectum on the seminal vesi- 
cles — is not so plausible as it would at first appear. 
These vesicles are so placed between the bladder and 
the rectum that they have free motion, and can thus 
easily give way to pressure coming from the rectum, 
so that the latter would be more likely to exercise 

1 Op. cit., p. 488. 



FORMS OF IMPOTENCE 229 

any action on the closely joined and well-fixed ducts 
and their orifices than on the widely diverging blind 
ends of these formations. But pressure on the ori- 
fices of the seminal ducts would rather have a closing 
effect than otherwise." 

The explanation of the origin of this liquid would 
have far more anatomical probability if applied to 
the prostatic humor. The prostata, as is known, is 
firmly fixed in the pelvis, and so placed between the 
fundus of the bladder and the expansion of the rec- 
tum, situated immediately above the anus (and par- 
ticularly well-developed toward the front) , that the 
hard feces must almost of necessity be pressed 
against the prostata by the pressure of the sphincter 
ani. I had repeated opportunities of examining 
microscopically sperm-like liquid which different 
men emitted during difficult defecation, and 
which they believed to be semen. In but few 
cases could I find any seminal filaments, and in 
these cases I also discovered other evidences of 
spermatorrhea. 

Very seldom are morbid pollutions produced by 
general diseases, as anemia, general debility, and neu- 
rasthenia. By the side of all these causes, which 
rarely come under observation, onanism remains al- 
most the only cause of morbid pollutions that invites 
closer medical attention. 

Why does onanism cause pollutions? We have al- 
ready answered this question. The conditions that 
make onanism more likely to cause morbid pollutions 
are the youthfulness of most onanists and the facil- 
ity with which they can, at any time and in any 



230 SEXUAL IMPOTENCE 

place, indulge in their evil habit. Excessive onan- 
ism, or onanism in general with individuals whose 
power of resistance is still low, causes, almost with- 
out exception, a state of slight inflammation about 
the ductus ejaculatorii. This inflammation pro- 
duces in the vessels that convey the sperm an irri- 
tability of so high a degree that it is altogether out of 
proportion to its cause, and this irritability is, with 
rare exceptions, the cause of the morbid pollutions. 
The congestion probably never reaches such a point 
that a catarrhal secretion could be ascertained. 1 A 
slight swelling and reddening of the pars prostatica 
urethras can always be traced, and upon this fact 
we may establish, with the greatest plausibility, our 
diagnosis of excessive onanism, if we exclude any 
previous gonorrheal inflammation of the urethra. It 
must, however, be remarked that the pollutions, if 
they last a long time, cause by themselves chronic 
inflammation of the caput gallinaginis. This swell- 
ing and reddening will generally disappear as soon 
as the morbid pollutions begin to pass over into that 
stadium which is commonly called spermatorrhea. 
In this the caput gallinaginis turns pale and atro- 
phies. This same cause probably induces the relax- 
ation of the orbicularis muscles of the ejaculatory 
ducts which is followed by a dilatation of the same, 
and, finally, by spermatorrhea. 

These local changes are probably the immediate 
cause of the pollutions, but neither can, with any 
reason, be considered an independent disease, as 

1 Fiirbringer, Eulenburg's Real-Encyclopadie, Bd. xiv, p. 
596. 



FORMS OF IMPOTENCE 23 1 

they are merely symptoms of the disease consequent 
on onanism. 

We have seen that the pollutions are caused by 
the irritation as well as the relaxation of the spermatic 
passages. An attempt has accordingly been made 
to distinguish two forms of morbid pollutions. How- 
ever valuable it may be in therapeutics, this distinc- 
tion cannot be accepted as valid, but must give way 
to the assertion that the states of irritation and of 
relaxation are different stages of one and the same 
disease. The former always precedes the latter, but 
both occasionally exist at the same time. 

When once the pollutions have become chronic, 
then we have also to deal with the influence of habit, 
which is sometimes quite incomprehensible in the 
case of many organs, and offers an obstacle to the 
cure of pollutions even when their causes have been 
removed. There are individuals who are naturally 
predisposed to morbid losses or effusions of semen, in 
whom they are caused by the most trifling excesses. 

The diagnosis of morbid pollutions is an easy task, 
but the diagnosis of spermatorrhea is frequently 
more difficult. It is absolutely indispensable that 
the semen be examined microscopically, whether 
discharged by ejaculation or otherwise, and the 
patient himself must be subjected to an examination 
with the endoscope. 

The results of such sperm examinations from mor- 
bid pollutions are of great variety. Spermatozoids 
are found in variable quantity, being absent only in 
spermatorrhea of a high degree. In the same patient 
suffering from morbid pollutions there are found, at 



232 SEXUAL IMPOTENCE 

one time, quite well-developed spermatozoa, appear- 
ing dark in the field of vision and provided with 
long tails, while at another time almost nothing 
but young formations with light, water-colored 
heads and short tails. A remarkable fact is that 
after a pause of several days between pollutions you 
will find the seminal filaments very sparing in the 
ejaculated semen, while the filaments appear more 
numerous in sperm from pollutions repeated after 
short intervals. 

I have made numerous microscopic examinations 
of sperm coming from pollutions. It has been 
mostly sperm from prisoners, and only in a few cases 
from private patients. These examinations have 
convinced me that the spermatic fluid of morbid pol- 
lutions does not differ from semen ejaculated other- 
wise, in the quantity or in the form of spermatozoa, 
if we exclude the comparatively rare cases of sper- 
matorrhea of a high degree. The difference is only 
in the lesser vitality of these filaments. 

The filaments in sperm ejaculated during inter- 
course are partly alive after a lapse of forty-eight 
hours, if the fluid has been preserved under favorable 
circumstances; those from pollutions are, without 
exception, dead after a few hours. Even sperma- 
tozoa coming from pollutions which the majority of 
authors would call physiological have much less vi- 
tality than others discharged in coitus, for instance. 
This can easily be demonstrated by the examination 
of semen from the same person, but discharged at 
one time in pollution and at another in coition. My 
experiences in this line are not in conformity with 



FORMS OF IMPOTENCE 233 

Fiirbringer's 1 views on the relations of the products 
of the prostata to the seminal fluid, though recent 
and at this time unfinished experiments have caused 
some doubts in my mind. 

The result of endoscopic examinations has been 
spoken of already, and we here add merely that, 
since the urethra of a patient affected with spermat- 
orrhea and pollutions is very highly sensitive, the 
introduction of a sound or of an endoscope necessi- 
tates the greatest care and gentleness possible. 

The result of an endoscopic examination is nega- 
tive only when the morbid pollutions are caused by 
hyperesthesia of the sexual centra — a case which is 
certainly very rare, since an individual whose ejacu- 
latory organs are in good condition may lie the whole 
night with an erection and be visited by erotic 
dreams without suffering any loss of sperm. The re- 
sult of an endoscopic examination may also be 
negative if the morbid pollutions have appeared 
among the sequelae of some nervous disease ; but this 
also would be true in the beginning only, because, if 
the pollutions continue during a longer period, 
changes about the ductus ejaculatorii begin to make 
themselves noticed. On the whole, the cause of pol- 
lutions has very seldom to be looked for in the direc- 
tion of the centra, because, in the great majority of 
cases, the excessive losses of semen are occasioned by 
local disease. 

In most cases of morbid pollutions the exterior ap- 
pearance of the sexual organs points to morbid 

1 Die Storungen der Geschlechtsfunctionen des Marines*. 
Wien, 1895, pp. 8, 9. 



234 SEXUAL IMPOTENCE 

changes. The penis and testicles with their sur- 
roundings have generally a flabby, withered look ; the 
testicles hang lower than they should, and are some- 
times sensitive to even light pressure. Almost with- 
out exception there is a diminution of the warmth, 
sensitiveness, and irritability of the exterior sexual 
parts. 

The general state of health and appearance of the 
patient are more or less sickly in proportion to the 
grade of disease. Here and there you may see per- 
sons having a very healthful appearance who are 
nevertheless affected with excessive morbid pollu- 
tions. When you set your eyes on such a mis- 
erable, pitiful being, who, although gifted with some 
power of resistance, nevertheless ends by losing 
health and sexual power, you involuntarily ask your- 
self whether he can possibly be the object of such 
poor raillery as may be read in Niemayer's " Manual 
of Special Pathology and Therapeutics." 

The patient is sickly in appearance, and presents 
the picture of exhaustion in most cases — without 
exception in cases of a high degree. The chief dis- 
orders or troubles make themselves felt in the diges- 
tive organs and in the nervous system, the delete- 
rious influence on virility being constant and finally 
destroying it totally. 

In this diminution of virility and in the incessant 
pondering over the loss of semen, repeating itself 
without remission and driving the patient to despair, 
is most often to be found the cause of the changes in 
the character which are nearly always observable in 
such patients. 



FORMS OF IMPOTENCE 235 

Although a rational investigator cannot, even by 
a thorough study of the pollutions, discover any ad- 
vantage in this kind of discharge of sperm, yet there 
have been among authors ones who, while arousing 
a horror of every copulation outside of wedlock, have 
gone so far as to speak of the pollutions as a wise pro- 
vision of nature. 

Thus there arise the questions, are the pollutions 
necessary, and are they of any advantage to man? 
' 'No" is the answer to both questions. I will not 
speak of the wasteful spilling of the precious fluid 
which had better be used for the creation of new hu- 
man beings, since it would be a real misfortune for 
mankind if all sperm were so used. The waste of 
sperm has its cause in the course of nature; but an- 
other circumstance claims our attention. The sex- 
ual power of man is one of those few real pleasures of 
our existence, and the pollutions deprive many a one 
of a considerable share of these enjoyments, which 
are in any case only sparingly meted out. Pollutions 
should never be allowed to exist in any one, for they 
can have only one of two things as their cause : either 
they prove a real want that is not satisfied, or they 
are the symptom of some disease. In the former 
case the individual concerned should do his utmost 
to obtain his share in the enjoyments of life; in the 
latter case the sufferer ought to seek help, as it is his 
duty to do. The main cause of the lack of spirit and 
the helplessness of these sufferers lies in the present 
views of the leading professional spirits. If they 
show any feeling for these pitiable individuals, it is a 



236 SEXUAL IMPOTENCE 

sympathizing shrug of the shoulders at best, or it 
may be a scorn, since life is not at stake. 

My conviction is that pollutions will soon be can- 
celled from the list of physiological functions, and 
treated as a pathological symptom. I am so much 
the more inclined to this view, as I am not aware 
that pollutions have ever been noticed in animals. 

The injurious effect of sexual excesses on the func- 
tional capacity of the sexual organs is an admitted 
fact, and has been generally rather exaggerated than 
underestimated, as is the case to-day. Many men of 
the medical profession, who felt it incumbent to play 
the role of moralist, have at all times decreed the 
most horrifying chastisements on disobedience to the 
sixth commandment of God. These gentlemen of 
such high morality have too often encroached upon 
the legislative power, but, luckily, they were not in- 
vested with executive power, and hence it comes that 
many members of frail humanity, so sinful ever since 
the time of Adam and Eve, continue unpunished, 
most of them meeting with punishments far less se- 
vere than those ordained in the penal codes of the 
above-mentioned legislators. 

On all sides and at all times has it been empha- 
sized that nature resents every infraction of her laws. 
This is essentially correct, but it is remarkable that 
most of the authors look upon such infraction as 
equivalent to excess only, and few of them state that 
not excessive indulgence alone but also excessive 
continence can harm the body and the sexual 
power. An explanation of this omission is chiefly 
to be found in the fact that real continence is prac- 



FORMS OF IMPOTENCE 237 

tised so seldom. It is well enough to exalt absolute 
continence, but its great rarity makes talking of it a 
positive waste of time. Thus I have no great faith 
in absolute continence, and believe the continent, 
with very few exceptions, to be onanists. Accord- 
ingly, I do not wish to speak of absolute, but only of 
relative, continence. 

In theory it will be easy to understand that sexual 
faculties not kept in sufficient practice are weakened 
thereby, and this for several reasons. Every gland, 
and consequently also the sexual glands, requires a 
certain amount of excitation of its nerves in order to 
produce energetic action. Every muscle, and con- 
sequently also the muscles of erection, can become 
strengthened only by exercise. All bodily functions 
demand appropriate gymnastics, the sexual func- 
tions no less than any other. It is quite noteworthy 
that authors even in our time are rather loath to ad- 
vance these truths, and they forget in some measure 
that " continued inactivity of nerves diminishes 
their irritability even to annihilation." 1 

A robust man with well-developed virility and 
powerful sexual instincts will never be in danger of 
making too sparingly use of his procreative power, 
at least not voluntarily. Such is more likely to oc- 
cur with people who are originally poorly provided with 
sexual strength and desires; and these are the very 
ones who cannot afford to do without reasonable 
gymnastics in sexualibus, just as weakly children re- 
quire bodily gymnastics more than stronger ones do. 

1 Landois, Lehrbuch der Physiologie des Menschen Wien 
und Leipzig, 1893, p. 674. 



238 SEXUAL IMPOTENCE 

Lallemand 1 expresses this very appropriately when 
he says, " No one will think that a delicate child ought 
to be kept from gymnastics because it shows in com- 
parison with its comrades less inclination and apti- 
tude for all kinds of bodily exercises." 

Since the sexual power plays such an important 
role in human life, it would seem natural that some 
efforts should be made to strengthen it. We are yet, 
however, at a great distance from practical and un- 
prejudiced views. Some seven years ago the Inter- 
national Congress for the Prevention of Venereal 
Diseases in Brussels, and right after that the German 
Society for the Prevention of Venereal Diseases, then 
the American Society of Sanitary and Moral Pro- 
phylaxis, later the Georgia and a number of other 
State Medical Societies passed resolutions declaring 
absolute sexual continence to be not injurious. That 
ought to settle this question, just as many other 
questions were settled forever and ever by the 
Tridentine and other councils. Too bad we cannot 
burn the unbelievers at the stake. 

Absolute sexual continence is not frequently to be 
encountered. Most physicians have very little or no 
experience in the matter, and it hardly makes any 
difference on which side of the question they vote. 

It is practically proven that continence, whether 
absolute or relative, induces a weakening of virility. 
This fact, which is in accord with theory and proven 
by practice, may seem to contradict the very com- 
mon experience that powers injured by sexual 
excesses recover during continence. This contradic- 

1 Pertes seminales, tome ii, p. 255. 



FORMS OF IMPOTENCE 239 

tion, however, is merely apparent, because in impo- 
tence resulting from sexual excesses the cause is not 
in the diminished secretion of the sexual glands or in 
a lowered capacity of the muscles, but in the tem- 
porarily weakened state of the nerves. During mod- 
erate continence the over-strained nerves and their 
centers have the necessary time to become calmed 
and strengthened; the glands and muscles cannot 
be injured in their capacity for action during a time 
of rest that is of only short duration. Continence is 
certainly not of equal importance with sexual ex- 
cesses, not because it is less pernicious, but because of 
its greater rarity. 

The commonest consequence of absolute or rela- 
tive continence is weakening of virility. Sometimes 
this weakening is preceded by a stage of great irrita- 
bility of the sexual organs, during which too fre- 
quent pollutions may set in and become permanent. 
Thus nature helps itself, but, of course, not without 
injuring the organism in another direction or way, 
since pollutions are never unattended' by pernicious 
consequences. In general, the sexual instinct disap- 
pears gradually if not roused from without. 

Absolute continence is so seldom the object of 
medical observation that we cannot say anything 
definite about the phenomena accompanying it. In 
this we also find the only explanation for the song 
that Acton sings in praise of continence. As to those 
who are approximately continent, daily experience 
informs us that they are seldom endowed with 
marked virile power, and I believe that they are 
naturally possessed of a low degree of sexual power, 



240 SEXUAL IMPOTENCE 

because a duly gifted man neither will nor can be con^\ 
tinent. Weakness and incapacity are sometimes ar- 
rayed in the garment of virtue. " In any case there 
is a close connection between the activity of the gen- 
erative glands in a pubescent individual and the de- 
gree of his libido." 1 Nowadays there are probably 
few who still believe the obsolete fable that sperm 
once secreted can be reabsorbed and then be of spe- 
cial benefit to the body. Elsewhere we have already 
stated, as far as our knowledge extends, what the 
internal processes during continence are, and what 
becomes of the sperm stored up in the glands that 
prepare it. 

The cases that are oftenest observed and that af- 
ford the clearest proofs of the weakening influence 
that continence exercises upon virility are those in 
which robust men are compelled to observe conti- 
nence. In this respect I have been particularly 
favored by having the opportunity of making my 
observations during the partial mobilization of the 
Austrian army when a part of it was for a time sta- 
tioned in Bosnia. Nearly all the officers, friends of 
mine, vigorous young men, told me that at first it 
was hard to submit to the abstinence forced upon 
them by the social circumstances ; but after a timj it 
was comparatively easy to bear. Even the yafeig 
gentlemen were not surprised at their ability to ab- 
stain, but their astonishment followed soon when one 
or another obtained leave of absence and expected to 
do wonders when at home. Instead, he had rather 
to remain on the defensive at first, at least, until the 

1 Krafft-Ebing, Psychopathia sexualis. Stuttgart, 1886, p. 30. 



FORMS OF IMPOTENCE 241 

novel excitations had again animated his sexual or- 
gans to new activity. 

Edward Martin 1 mentions prolonged continence 
as one of the causes of atonic impotence in cases 
where the instinct is strong and where the mind has 
long been given up to amorous desires. This au- 
thor thinks the reason for it lies in the "prolonged 
congestion which does not receive its normal physi- 
ological relief." The same author states further 
that " in some cases the organ is so poorly developed 
that a successful intercourse is well-nigh impossible. 
This is generally observed in those who have been 
continent. In such cases local exercise may act as 
beneficially as it does upon other parts of the body." 
Loewenfeld 2 relates a number of cases where ab- 
stinence has caused various neuroses, hallucinations, 
and even conditions bordering on real insanity. 

It is to be regretted that in our complicated consti- 
tution abstinence is never conducive to the develop- 
ment of sexual strength, though it may be borne with 
relative impunity by some individuals. Having 
stated the truth, we care but little for the indict- 
ment of the "holier than thou" people. 

Preaching can certainly do no good, and it would 
be necessary for the social conditions to change radi- 
cally, before a man could really " blush for his own 
sex" or be influenced by the far-fetched thought 
that he is in a special case " violating the sex of his 

1 Impotence and Sterility. Hare, System of Practical Thera- 
peutics. Philadelphia, 1882, vol. iii, pp. 661-663. 

2 Sexualleben und Nervenleiden. Wiesbaden, 1899, pp. 41 
to 50. 

16 



V 



242 SEXUAL IMPOTENCE 

mother." 1 The man who is able to "appreciate his 
virginity preserved to an advanced age as a pearl of 
great price," may be very virtuous, but Scott is 
surely mistaken in his poetical opinion that any 
woman would ever have reason to sing: "0 happy 
she whose lips he presses! O happy she whom he 
caresses!" I am afraid that even James Foster 
Scott 1 will fail in his garrulous effort at perfecting 
mankind, as man has never been improved by 
scolding. 

" What we as physicians are called upon to do is 
to combat, with all the strength that lies in our 
power, not only the evil, but the fatuity of those who 
pretend to be piously unaware of its existence." 2 

Having now discussed the more frequent causes of 
neurasthenic impotence, we shall treat separately a 
few of the more prominent forms. 

All kinds of sexual excess lead frequently to the 
different grades of paralytic impotence. Complete 
paralysis of the sexual nerves and centra occurs prob- 
ably rather seldom as long as the rest of the body 
keeps healthy and robust. In senile impotence it is 
constant. More frequently we notice the other nu- 
merous forms of sexual neurasthenia, every one of 
which may pass over into paralytic impotence. 

In the first instance we have the so-called irrita- 
ble weakness, which is on the confines between 
diurnal pollutions and sexual neurasthenia, but dif- 

1 James Foster Scott, The Sexual Instinct. New York, 
1900. 

2 Bierhof, A Study. Philadelphia Monthly Med. Journal, 
July, 1899. * 



FORMS OF IMPOTENCE 243 

fers from morbid pollutions chiefly by the absence of 
any material change in the sexual organs. The irri- 
table weakness consists generally in a highly ex- 
aggerated sexual irritation, but with which erection 
does not keep pace, for erection is either incomplete 
to start with or it becomes complete only after long 
exertions. In either case, however, the ejaculation 
is precipitate and in advanced cases occurs even be- 
fore the introduction of the penis into the vagina. 
This disease must not be confused with a precipitate 
ejaculation with incomplete erection that may occur 
quite normally with most men after an unusual 
abstinence, and due to overdistension of Henle's 
ampullae and the vesiculas seminales. 

We need not add anything about the disagreeable- 
ness of this disease, but it is the clearest proof of the 
incorrectness of the assertion that the pleasure lies in 
the ejaculation alone, which opinion has been shared 
and upheld by many authors. Premature or preci- 
pitate ejaculation deprives the man, and still more 
the woman, of the due pleasure; it may, moreover, 
be an obstacle to conception, because with the few 
motions of coition, or even their entire absence, 
there is no orgasm caused in the woman, this being 
generally a condition essential to conception. It is 
curious that Finger 1 tries to prove by such pathologic 
conditions that the center of ejaculation is more re- 
sistant than the center of erection. 

If the precipitate ejaculation is caused by disease 
of the ampullae, the seminal vesicles, the ductus 
ejaculatorii or of the colliculus seminalis, it remains 

1 Op. cit., pp. 6 aifti 36. 



244 SEXUAL IMPOTENCE 

constant and repeats itself without exception at 
every coition. If the precipitate ejaculation is 
based upon irritable weakness as a form of sexual 
neurasthenia, then it is varying like all other neu- 
rasthenic diseases. The ejaculation may then take 
place, at one time before the penis enters the vagina ; 
at another time it may occur after a few movements ; 
again, the coitus may be accomplished quite nor- 
mally, and at some other time ejaculation may even 
be delayed. 

In purely neurasthenic cases of irritable weakness 
we shall not find that exaggerated erethism of the 
urethra which Ultzmann 1 speaks of, and which can 
always be noticed when the " irritable weakness" 
is caused by organic changes about the colliculus 
seminalis. 

There are neurasthenic individuals who have pre- 
cipitate ejaculations with one woman, though they 
can have quite normal coitions with other women. 
Most neurasthenic persons get over the first attempts 
at coition with a new acquaintance with difficulty 
only, and the first are generally unsuccessful at- 
tempts. Such men must first get accustomed to 
their new acquaintance. Their very vivid imagina- 
tion must first be somewhat pacified; then they 
recover their normal condition for the time they 
associate with that same woman. This, however, 
is not lasting with most neurasthenic patients, 
because they soon conceive an aversion for the 

1 Potentia generandi und Potentia coeundi. Wiener Klinik, 
1885, Heft 1, p. 25. 



FORMS OF IMPOTENCE 245 

woman in question, and their disease is thus the 
cause of their inconstancy. 

The irritable weakness attended by organic 
changes in the sexual apparatus should, in my opin- 
ion, be classed rather with morbid pollutions. It has 
its cause nearly always in excessive onanism. Such 
individuals, besides, suffer almost without exception 
from frequent pollutions. 

Excessive onanism, pollutions, sometimes onan- 
ism habitual though not excessive, are in like man- 
ner capable of causing neurasthenic irritable weak- 
ness. It is not onanism exclusively that causes this 
form of disease. Sometimes a congenital predis- 
position to neurasthenia, or other neurasthenic 
disorders, cause temporary or permanent irritable 
weakness. At other times the cause may be mental 
onanism and excitement immediately preceding 
coition. There are, besides, single forms of irritable 
weakness that originate in or arise from an over- 
sensitiveness of the glans; this is the case especially 
with individuals whose glans is entirely covered by 
an easily retractable prepuce, and is exceedingly 
sensitive to touch. 

When considering and estimating such conditions, 
it must not be forgotten that whenever there are 
signs of increased irritability of the nerves, we are 
nearly always in the presence of the first stages of de- 
terioration of nerve energy. From all the above cir- 
cumstances we must infer that it is not true that 
all forms of impotence through irritable weakness are 
" spinopherous or preponderantly spinal/' 1 

1 Eulenburg, Sexual Neuropathie. Leipzig, 1895, p. 28. 



246 SEXUAL IMPOTENCE 

A rather common form of impotence is that kind of 
sexual neurasthenia which is generally called psy- 
chical impotence, which might with more pro- 
priety be named hypochondriac impotence. We very 
seldom see a purely psychical impotence in which 
the sexual organs and their connection with the 
central organ as well as the entire nervous system, are 
perfectly healthy. There may be very impression- 
able individuals who are apparently healthy in every 
respect, and yet may become temporarily impotent 
simply by the effect of the thought that they are im- 
potent, or by the fear of not being able to give satis- 
faction in a certain case. Such individuals are 
evidently healthy in appearance only; but, like a 
hypochondriac who suffers from an evil that is real, 
though he magnifies it, so also is the psychically im- 
potent man afflicted with some organic defect which 
only careful examination may reveal. Then it is 
found without exception that these are neuras- 
thenics suffering from psychical impotence, and are 
generally people who have weakened their sexual 
organs and burdened their conscience through 
onanism or some other mismanagement of their sex- 
ual power. They need intense excitement to obtain 
an erection necessary for coitus. Their centers of 
erection must be blunted and their inhibitory centers 
just as sensitive, since a mere thought is often suffi- 
cient to excite the latter and paralyze the former. 

In psychical impotence it must further be remem- 
bered that every thought likely to divert the mind 
from the act in contemplation can also prevent erec- 
tion altogether or overcome it if already begun. 



FORMS OF IMPOTENCE 255 

rule that those occupations in which labor is per- 
formed without fatigue and accompanied by a 
certain amount of mental exercise, and those mental 
occupations that are relieved by the requisite amount 
of physical exercise, are the callings that present the 
most vigorous men. 

The Talmud treated the members of the learned 
professions to an exceptional favor by granting them 
the privilege of intercourse with their wives once in 
two or three years, while the wives of others had a 
legitimate claim upon their husbands at least once a 
week. Bookworms are generally weak in sexuali- 
bus, as has been known for thousands of years. 
Many a one may, like Rousseau, have received from 
some experienced lady the confidential advice, 
"lascia le donne, e studia la matamatica," without 
making so much ado about it. Part of the cause is 
in the sedentary life of these men, which is not con- 
ducive to health; and part is in the over-exertion of 
the brain, that is apt in the course of time to aggra- 
vate the neurasthenia which exists often a priori with 
men who are inclined to mental efforts. This, then, 
will in the end bring about a new diminution of the 
sexual power. Besides, intense mental activity 
exercises the thinking parts of the central nervous 
system to the detriment of the sensitive and motor 
parts. 

If artists and scholars, as painters, actors, authors, 
physicians, professors, etc., are sometimes reported 
to be not disinclined to love, or to be sensual, this is 
no proof of the contrary, because the presence of sen- 
suality does not imply that of sexual strength. 



256 SEXUAL IMPOTENCE 

Withal, we see that highly intellectual and learned 
men are often possessed of a considerable wealth of 
children, so that Nordau's 1 dictum, "From common 
men we obtain the conservation, from great minds 
the intellectual advancement, of our species. The 
same individual cannot be equally capable of pro- 
ducing both thought and children," merely repeats 
a popular dictum not supported by fact. The best 
thought has come from people who have also pro- 
duced children; while but few impotent men can 
console themselves with the fancy that their weak- 
ness has not prevented them from producing at least 
good thought. 

Some authors advance the idea that people who 
attach great importance to an excellent table, the so- 
called epicures, possess but little sexual impulse. For 
my part I must state that I have observed the oppo- 
site condition only — the so-called great eaters are 
also great worshippers of the fair sex until the time 
when the superfluous quantity and the wrong qual- 
ity of nourishment induces obesity, and obesity 
grows from day to day more hostile to Venus. 

In all ranks and conditions of life there are to be 
found people with extraordinary virility, and others 
with weak sexual power. It is a matter of course 
that people who are preoccupied by cares, ambition, 
or any other unusually absorbing state of mind, have 
little time to spare for love and sexual affairs. They 
consequently have a weaker sexual impulse than 
others who devote a great part or even the whole of 

1 Max Nordau, Die conventionellen Liigen. Leipzig, 1886, 
12, Auflage, p. 123. 



FORMS OF IMPOTENCE 257 

their time to pondering over sexual matters. This 
is the reason why great workers, whether physical or 
mental, endure sexual abstinence very easily; but 
only in case they have been abstinent to begin with. 
Scholars, for instance, who have only in the course of 
time taken to study, cannot stand absolute conti- 
nence even during uninterrupted study. They are 
seized with vertigo and uneasiness in the midst of the 
most intense mental efforts, these evils not abating 
until sexual satisfaction has been obtained. I have 
had occasion to watch more than one case of this na- 
ture, and the patients have always experienced good 
results by following my advice — viz., to give up ab- 
solute abstinence. 

Finally, I must once more refer here to the notion 
that has descended from Hippocrates to Lallemand 
and Roubaud. In spite of Hippocrates and his fol- 
lowers, I repeat that riding cannot exercise an inju- 
rious influence on the sexual power. A single glance 
given to cavalry will convince to the contrary. Not 
to mention my own experience with cavalries of dif- 
ferent countries, I will point to the fact that where 
horse-rearing is carried on and horseback-riding is 
very common the number of births, both legitimate 
and others, is rather above the average, and the 
morality of such places is somewhat light. In con- 
sideration of all this it is obvious that riding is no 
hindrance to the development of the sexual power. 

SENILE IMPOTENCE. 

The energy of the bodily functions diminishes with 
the advance of age. The sexual function, being one 
17 



258 SEXUAL IMPOTENCE 

of the last in its development, is also the first usually 
in the file of the functions that gradually desert the 
body, growing by degrees weaker. Old men conse- 
quently are impotent according to the course of na- 
ture, and yet there are very old persons who can still 
accomplish something remarkable in sexualibus. 

We must admit a difference in old people, consid- 
ering more the condition of the body than the num- 
ber of years. Appearance alone often deceives, as 
we may see old persons whose bodies have preserved 
all their forces but the sexual. The reverse is hardly 
ever seen, with the exception of those pathological 
cases where in decrepit old men there is a sexual im- 
pulse quite out of proportion. There are perfectly 
vigorous old men, as there are also quite decrepit 
young people. Every physician has opportunities of 
observing men of seventy or more years who possess 
excellent power of assimilation of material and also 
quite energetic sexual functions. 

Chouryguine, * who dissected the sexual organs of 
twenty-one individuals fifty-five to eighty-eight 
years old, found various and considerable structural 
changes in the blood-vessels, the nerves and their 
endings, the tunica albuginea, and the corpora cav- 
ernosa. These alterations alone could explain the 
ensuing sexual incapacity without any regard to the 
condition of the sexual centra in the brain and the 
spinal cord. The degenerative changes, however, 
did not always correspond with the age of the in- 
dividual, and were sometimes found in relatively 
young men. The autopsies of old men made by 

iVratch, Dec. 18, 1897. 



FORMS OF IMPOTENCE 259 

Duplay, Dieu, and others show that even octogena- 
rians may have well-developed spermatozoa, which, 
however, does not prove that they are virile, but 
only that they may be so. After all, sexually vigor- 
ous old men are exceptions, because the functional 
capacity of the sexual organs generally begins to di- 
minish with the fiftieth year, continuing to decrease 
until the sixty-fifth year, when it is generally 
extinct. 

As the greatest individual differences prevail in this 
respect, it is quite impossible to set a fixed time for 
the beginning of physiological senile impotence. Nor 
is it possible to determine in every case why such or 
such an individual has grown impotent in early life 
while another is still perfectly vigorous at an ad- 
vanced age. It is noticed that in some families a 
premature impotence and in others a tardy extin- 
guishment of the sexual power is, so to speak, heredi- 
tary. Some individuals who have been healthy and 
strong all their lives remain sexually vigorous to a 
good age. Again, other individuals are seen who 
have always used with prudence their sexual power, 
and possess otherwise the requisite qualities, pre- 
serving their manhood to an advanced age. Too 
frequent excesses, especially in onanism in youth, 
and over-careful husbanding of the sexual power are 
the greatest enemies to the preservation of virility. 
It is extinguished earliest in individuals in whom it 
has never appeared with impetuosity, and who, on ac- 
count of this feeble desire, have acquired renown for 
virtuousness. It disappears latest in those who may 
now and then have given rein to their impetuous im- 



260 SEXUAL IMPOTENCE 

pulse, but without going in their enjoyment beyond 
a reasonable measure — who have, in a word, given 
off at all times only what they could easily spare. 

Normally the extinguishing of the sexual power 
takes place gradually, the act can be performed less 
and less frequently, and while the erections may be 
quite vigorous at times, it requires more and more of 
an incitement to reach the final orgasm. I was re- 
peatedly consulted by old men who claimed that de- 
sires and erections were satisfactory, but ejaculation 
of semen could be obtained only with great efforts or 
not at all. In such cases the advice must be: hy- 
gienic life in every respect, improving of bodily condi- 
tions, and safe husbanding of the remaining sexual 
ability. 

Only a superficial observer will be surprised at see- 
ing one individual quite impotent when old, after 
having solicitously spared his sexual power all his 
life, and another, known as an epicurean, who still 
possesses a certain degree of sexual vigor in spite of 
his advanced age. Medical science must not be 
unfair toward such exceptions, which are frequent 
enough. It must not thoughtlessly follow the dic- 
tum of the past, and deny them every sexual power, 
together with the right to make use of it. I am 
aware that these old veterans will not care for the 
well-intended but strict prohibitions of too scrupu- 
lous medical authorities. I know they will, all the 
same, put into practice their right as much as possi- 
ble and feasible, and I will frankly oppose my opinion 
to those scruples and say that old people run no risk 
in satisfying real sexual wants. 



FORMS OF IMPOTENCE 261 

Malchow 1 evidently is of the same opinion, as he 
says: "There is nothing that will give such life to 
both men and women and make them feel and 
remain young, as the conviction of their own virility 
and sexual activity; nor is there anything to com- 
pare with the salutary effects of reasonable sexual 
exercise." 

Of course, I am not including here those pathologi- 
cal cases of an increased or reawakened sexual im- 
pulse in old age after it had become extinct. I am 
speaking here only of preserved sexual vigor in ad- 
vanced age. I believe that satisfying real sexual 
wants can be but advantageous to old age, as it con- 
tributes to stimulate the energy in the assimilation of 
material; it buoys up and makes the heart rejoice; 
it helps to keep up cheerfulness, which is generally 
reduced in old people, and therefore may properly 
be considered as a means of favoring longevity. 
Malchow calls it "the rejuvenating influence of 
conscious possession of an ability for the expression 
of love." 

As to those cases in which death occurred soon 
after some old gentleman had entered into married 
life, or those cases of sudden death before, during, or 
after coition, nothing is proved by them, since we 
hear every day of persons dying slowly or suddenly 
without having thought of marriage or of sexual in- 
tercourse for a long time past. Again, we also see 
men rejuvenated by the side of young wives and liv- 
ing to an advanced age. At any rate, those old men 
who are still in possession of a good remainder of 

1 The Sexual Life, Mosby, St. Louis, 19 13, p. 299. 



262 SEXUAL IMPOTENCE 

their sexual power have a better prospect of a long 
life than those who in a decrepit state are condemned 
to a virtue which is not always voluntary. 

Modern authors are beginning to conform to these 
ideas. Edward Martin, 1 for instance, knows "of 
one man who at the age of seventy-eight has begot- 
ten a child, and who states that his erections are as 
vigorous as in youth, and that he performs the sexual 
act frequently and satisfactorily. This man's pow- 
ers are possibly kept alive by his marriage with a 
young and vigorous woman." 

1 Impotence and Sterility. Hare, System of Practical Therapeutics, 
vol. iii, p. 661. 



CHAPTER V. 

DIAGNOSIS. 

Although the causes are manifold, yet all the 
forms of impotence have this in common, that the 
diagnosis is in the first instance based upon the sub- 
jective sensations and observations of the patient 
himself. It is well known how unreliable the state- 
ments of patients are. Objectively there is very little 
to discover in most of these forms ; while in some the 
external sexual organs show various degrees of flac- 
cidity, shrinkage, and paleness. An endoscopic in- 
spection of the urethra reveals in most cases differ- 
ent degrees of paleness of the mucous membrane, and 
in nearly all cases that are associated with involun- 
tary loss of sperm various degrees of inflammation of 
the colliculus seminalis are discovered. The result 
of such inspection is sometimes negative. 

These points of diagnosis are of importance though 
not always present. The physician must never fail 
to examine minutely the sexual organs with the endo- 
scope and otherwise, because the positive or negative 
result will yield some points in eliciting the causes and 
helping to determine the appropriate treatment. 
The objective results, whether positive or negative, 
together with the statements of the patient, must 
then form a whole, from which the physician will de- 
duce his opinion, or, relying on which, he will engage 

263 



264 SEXUAL IMPOTENCE 

in further investigations. The result of an endo- 
scopic inspection is in many cases very important. 
Unfortunately, many persons are very sensitive to 
the use of an endoscope, and this is easy to under- 
stand if we consider that they are in many cases 
neurasthenic and timorous. Proper encouragement 
and confidence in the result will, however, persuade 
the impotent to submit to almost anything. 

When any one consults me upon impotence, I 
begin with close questioning; after this I proceed 
to the inspection of the exterior of the whole body, 
and particularly of the sexual organs. The patient 
is instructed to void urine, the latter is then examined 
chemically and microscopically. By following 
Heitzmann's 1 teachings and with some practice 
pathologic conditions that may have more or less 
bearing upon the complaint can not infrequently be 
detected by intelligently reading the findings of a 
small drop of centrifuged urine under the micro- 
scope. The clinical symptoms can sometimes be 
explained or corroborated, chronic prostatitis, vesi- 
culitis or spermatorrhea detected. This is followed 
by an endoscopic examination, and, in conclusion, I 
question the patient about the various points that 
may have been observed during the inspection. 

A physician on the point of engaging in some treat- 
ment or other from which he expects any satisfac- 
tory result must know regarding his patient the age, 
hereditary conditions, occupation, constitution, man- 
ner of living, previous diseases and sexual life, pres- 

1 Urinary analysis and diagnosis. Second edition. New 
York, 1906. 



DIAGNOSIS 265 

ent state of health, and every detail of the existing 
degree of impotence. He must, besides, subject to a 
careful examination the whole body of his patient, 
and especially the genitals. The penis as well as the 
testicles, the spermatic cords, the prostate and semi- 
nal vesicles must be examined in regard to size, the 
amount of blood they contain, and their sensitive- 
ness. The introduction of the endoscope will indi- 
cate at once the width and sensibility of the urethra, 
the color and other conditions of the urethra, and 
especially of the colliculus seminalis. 

Peterkin 1 of Seattle has perfected a scientific 
method of examining the genito-urinary system 
which really covers all possible points, and should be 
studied and merits to be considered as a model. 

The diagnosis is easy in most forms of impotence, 
but is subject to frequent mistakes on account of the 
unreliability of the statements of the patient. Mod- 
esty, ignorance, false notions, excessive timidity, and 
an inclination to falsehood are the commonest causes 
that induce a patient to make many a wrong state- 
ment wittingly or unwittingly. 

There is no difficulty in the diagnosis of congenital 
or acquired defects in the formation of the external 
genitals. In cases where the congenital defects con- 
cern the internal genitals, without any outward signs, 
some light may be thrown upon the question by en- 
doscopy and by a microscopic examination of the 
sperm. 

In impotence following some disease not located in 
the region of the genitals the diagnosis of the primary 

1 Am. Journ. of Dermatology and Gen. Ur. Dis., Sept., 19 10. 



266 SEXUAL IMPOTENCE 

or causative disease is sufficient to elicit the cause of 
the impotence, and then, generally, there are no cor- 
responding pathological changes about the genitals. 

In some, though very few, cases of inherited pre- 
disposition to impotence the diagnosis is very diffi- 
cult, because the appearance of the patient and also 
the condition of the visible sexual organs seem to 
contradict the statements of the patient. Again, in 
other cases, while the external genitalia may not ap- 
pear to correspond to the condition of the rest of the 
body, no sufficient explanation is presented for the 
complete impotence that exists ; hence the physician 
must depend largely upon the statements of the pa- 
tient for a diagnosis. The local temperature and 
electro-sensibility are in such cases of particular 
importance. 

In the neurasthenic forms of impotence resulting 
from abuse of the sexual power the conditions vary 
greatly. In some cases there is absolutely nothing 
to be established objectively, except a diminution in 
the sensibility and electrical irritability. In other 
cases, again, we find abnormal pallor and laxness in 
the external sexual organs, with or without local 
inflammation in the ductus ejaculatorii and neighbor- 
ing parts, always associated with paleness of the 
urethra. Griinfeld 1 states that in onanists he found 
hyperemia of the colliculus seminalis nearly constant. 
The usual signs are dark-red, even scarlet color, and 
hypertrophy associated with slight vulnerability of 
the colliculus seminalis. In spermatorrhea Griinfeld 

1 Die Endoscopie der Harnrdhre und Blase, Deutsche Chir- 
urgie. Stuttgart, 1881, Lieferung 51, p. 173. 



DIAGNOSIS 267 

found catarrhal swelling of the colliculus seminalis. 
In highly developed spermatorrhea accompanied by- 
impotence a yellowish-red coloring takes the place of 
the reddening of the mucous membrane. In individ- 
uals suffering from pollutions Griinfeld found in 
some cases a kind of hypertrophy of the colliculus 
seminalis. Such results or conditions may be re- 
corded by every endoscopist, and are at present, 
with our improved instrument arium, easily brought 
into view. The objective findings will vary accord- 
ing to the nature of the abuse that has taken place. 
In cases induced by excessive onanism we find, 
without exception, laxness and pallor of the penis 
and testicles, a smooth scrotum, and low-hanging 
testicles in consequence of the relaxation of the 
muscular fibers in the tunica dartos. The orifice 
of the urethra is reddened, the rest of the urethra 
pale as far as the colliculus seminalis, and this latter 
is in different degrees of inflammation. 

The vaguest signs are presented by those cases of 
impotence which have arisen from excesses in ven- 
ery. In forms of impotence consequent on absti- 
nence the result of examination is only apparently 
negative, since the testicles always show smaller 
dimensions than normal, although the penis may 
not show any change in its form. 

The objective result in the external form of the 
sexual organs is always of relative importance, be- 
cause it has first to be compared with the former 
state before a conclusion can be arrived at about the 
abuse that has taken place. 

Generally negative results are obtained in the ob- 



268 SEXUAL IMPOTENCE 

jective examinations of the sexual organs in those 
forms of sexual neurasthenic impotence which have 
not been caused by a mismanagement of the sexual 
power, but are founded entirely on a neuropathic 
predisposition; for instance, relative impotence not 
induced by weakness never presents any pathological 
changes. In the other neurasthenic forms — as, for 
example, so-called psychical impotence — we dis- 
cover here and there signs of atony of the sexual 
apparatus, and, besides this, in so-called irritable 
weakness we discover sometimes different grades 
of inflammation of the colliculus seminalis. 

Dr. Albert Abrams claims that he can measure 
virile power by biomechanic means. The apparatus 
which he has constructed for this purpose and 
described in his book is known as "Sphygmo- 
biometer." In diagnosing syphilis I have seen 
most remarkable achievements of this apparatus. 



CHAPTER VI. 

PROGNOSIS. 

There is nothing to be said about prognosis in 
general, since every individual case carefully consid- 
ered has first to establish fundamental points on 
which may be grounded a prognosis that even then is 
not always reliable. 

The prognosis is absolutely unfavorable in cases of 
absence of the penis, of both testicles, of excessive 
smallness of the sexual organs, of excessive hypo- 
spadia or epispadia. It is more or less favorable in 
the other kinds of organic impotence. 

In the forms of impotence dependent on other 
bodily defects the prognosis is based entirely on the 
physician's ability to remove the primary disease. 

The prognosis in the forms of congenital impo- 
tence is always doubtful, because we seldom succeed 
in the treatment of inherited defects or abnormalities 
of the sexual instinct, or in the effort to lead it into 
more natural channels. 

In the forms of neurasthenic impotence following 
bad management of the sexual power the prognosis 
is different, depending on the symptoms in each 
individual case. In cases accompanied by persistent 
pollutions the prognosis is always doubtful, because 
we can never know whether the pollutions or sperma- 
torrhea can be mastered. In impotentia ex absti- 

269 



270 SEXUAL IMPOTENCE 

nentia also the prognosis is doubtful in case atrophy 
of the testicles has already set in. The prognosis is 
generally favorable in the forms of so-called psychi- 
cal impotence. 

My personal experience proves to me that Eulen- 
burg 1 is not absolutely correct when he makes the 
statement that the prognosis is better in cases of 
merely functional injury, in hyperesthesia of the 
prostata and pars prostatica, than when there are se- 
rious and palpable structural changes, such as cysti- 
tis, prostatitis, strictures, etc. I would declare this 
assertion correct only in reference to grave "struc- 
tural changes," in which case I should, however, not 
include cystitis or stricture, nor even simple prosta- 
titis. For my part, I much prefer to find those 
structural changes to be the cause of the impotence 
or sexual neurasthenia than to discover that the neu- 
rasthenia is an independent disease. In purely neu- 
rasthenic disorders the successful treatment is not so 
easily accomplished as in cases of curable structural 
changes. 

The prognosis in general depends on the result of 
the examination. We can augur it to be favorable 
in case of youth or, at least, early manhood, strong 
constitution, otherwise sound general health, pre- 
served sensibility, electrical irritability, normal tem- 
perature, and vascularity in the sexual organs. The 
absence of these conditions makes the prognosis 
correspondingly doubtful, or even positively un- 
favorable. 

The physician should, however, always bear in 

1 Sexuale Neuropathie. Leipzig, 1895, p. 33. 



PROGNOSIS 271 

mind that there are few persons impotent through 
any cause except old age who cannot profit by a 
rational or judicious treatment. Consequently he 
must engage in the treatment of impotence with just 
as much zeal and courage as he would display in the 
treatment of any other curable disease ; and he may 
feel convinced that by the cure of one impotent indi- 
vidual he will dry many tears and do a great amount 
of good. 



CHAPTER VII. 

PROPHYLAXIS. 

"Medicina est conservatio sanitatis et curatio asgritudinis." 

It must be granted by all that impotence is one of 
the modern diseases. A physician who pays no 
attention to impotence has no conception of its 
great prevalence, nor does he understand that young 
people may be impotent without any one suspecting 
it. Very few have the courage to consult a doctor 
about these maladies honteuses, as they are called by 
all civilized nations. 

Only an insignificantly small proportion of those 
who have become prematurely impotent owe this 
severe infirmity to an inherited congenital or inno- 
cently acquired deformity or disease. The majority 
have become prematurely impotent because they 
have been left to themselves and to chance. How- 
ever well an individual may be led and directed in 
general, in the most important concern of life, the 
sexual life, he commonly receives no guidance. If 
one is possessed of spirit or energy and common in- 
telligence, he may now and then, in his sexual experi- 
ences, stumble into different snares ; but if no serious 
injur} 7 is sustained, he may eventually attain senile 
impotence, the natural goal of a healthy man. How- 
ever, an unlucky accident or the following of a mis- 

272 



PROPHYLAXIS 273 

directed path may lead to a disease that brings a 
speedy end to virility. 

So, before we can speak of a general prophylaxis of 
impotence, we should first feel convinced that it is 
highly unwise to allow any young man to enter upon 
the path of physical love, which is strewn with thorny 
roses, without furnishing him first with some good 
instruction. It is true, most men acquire a certain 
experience in time; but, alas many pay for it very 
dearly, and often with the loss of their power. 

The prophylaxis of impotence is closely connected 
with the prophylaxis of onanism, because the great 
majority of all those who have become prematurely 
impotent commenced with onanism at an early age. 
First of all is required a strict but loving and rational 
surveillance of the children. Next comes instruc- 
tion as soon as the first signs of puberty appear. This 
instruction, however, should be given without heat- 
ing the imagination and without the help of those 
books of horror, the so-called popular scientific 
works, which generally contain some piquant stories. 

When a child has given evidence that he practises 
onanism, every possible effort should be made in or- 
der to induce him to desist from the evil habit. The 
details of the various ways of discovering onanists, 
the methods for curing the evil with its consequences, 
etc., cannot be treated here at length. All this may 
be found in special works, and we wish particularly to 
mention that of Fournier. 

In the treatment of onanism the individual has to 
be carefully studied : not every child, nor youth, nor 
even man, has sufficient will-power to combat suc- 
18 



274 SEXUAL IMPOTENCE 

cessfully this evil so difficult to conquer. In many 
cases the object will be attained by incessant watch- 
ing, or ultimately by the application of a suitable 
preventive apparatus, which the child must wear day 
and night. 

Mature individuals should be advised to satisfy the 
sexual instinct in a natural way, and no notice must 
be taken of the cry of horror uttered by pharisaical 
medical authorities or by those who, although pos- 
sessed of great scholarship, are nevertheless destitute 
of experience. 

Of course, we must not forget that we are tread- 
ing a narrow path; between the Scylla of onanism 
and the Charybdis of venereal infection, to which 
a careless and promiscuous sexual life almost in- 
variably leads. A great deal of tact and experience 
are required to enable one to give the proper advice 
in every single case. 

The notion that whoever has once enjoyed natural 
copulation will not feel tempted to return to onanism 
is an error, somewhat prevalent. Only copula- 
tion that is practised regularly, satisfying every 
strong and real desire, can cure onanism ; while copu- 
lation enjoyed at long intervals only, would rather 
incite to more frequent onanism, because pleasing re- 
collections are near at hand. 

We know that absolute continence is attended by 
bad consequences ; it gradually extinguishes the sex- 
ual power, and does so the sooner and the more easily 
the weaker the original virility. It is really ludi- 
crous for Bourgeois 1 to admit that he prefers noctur- 
1 Les passions. Paris, 1877, p. 123. 



PROPHYLAXIS 275 

nal pollutions to coition, and to ask why one cannot 
leave the sexual organs inactive and enjoy good 
health. He points to the peasant, who does not 
exercise his mind, and the prisoner, who does not 
fatigue his apparatus of locomotion. 1 No doubt this 
may be true, but surely the virility of the abstinent 
will be as great as the peasant's intellectuality and 
as good as the chained prisoner's health. 

We have already stated that it is utterly impossible 
to fix a general rule as to how often coition is to be 
accomplished. Personal disposition and force, phe- 
nomena preceding and succeeding coitus, are proper 
guides to show each reasonable individual where the 
line of sufficiency is drawn. Every effort beyond 
this is injurious. No individual should take another 
as an example for his own conduct, because constitu- 
tion, hereditary condition, temperament, age, educa- 
tion, manner of living, occupation, state of health, all 
are active in establishing differences in sexual vigor, 
either for the time only or permanently, and it would 
be perfectly useless to combat these influences. Let 
each man be satisfied with what has been bestowed 
upon him. 

Timorous patients, and healthy persons, also, who 
see in their doctor their best friend, often ask what 
part of the day or the night is the most appropriate 
for coition. 

My answer is invariably, that moment which is 
most convenient and when the sexual desire is most 
urgent. From an esthetic point of view the evening 
hours are the time for love. Persons with weakened 

1 Bourgeois, op. cit., p. 119. 



276 SEXUAL IMPOTENCE 

virility are accustomed to take advantage of the erec- 
tion in the morning. Some medical men have ut- 
tered their veto against this habit, but this veto is un- 
reasonable, since, when the erection is not indicative 
of a real want, the member slacks at the first move- 
ments and coitus cannot be accomplished. 

The physician is also frequently asked in what po- 
sition the act ought to be carried out. Here also a 
brief answer is all that is due; all positions except 
the upright are equally advisable from a hygienic 
standpoint. If the ecclesiastic prescriptions on this 
subject are disregarded, the most convenient posi- 
tion is the one to choose. Coitus a parte postica is 
decidedly the most natural and favorable for genera- 
tion. It is also the most convenient way for corpu- 
lent persons. This is the mode that is said to be fol- 
lowed always in Australia, because the genitalia of 
the women there are placed a little farther back. 1 
The Jews believed that cotion in the usual way pro- 
duced children who were generally not so good, wise, 
or talented, and did not give ground for so much 
hope, as those resulting from copulation a parte pos- 
tica. This doctrine was an abomination in the eyes 
of Mohammed, and therefore he stated, according to 
the Hediths (traditions) , that the following verse of 
the Koran had descended from heaven : " The woman 
is your field; come into your field by whatever way 
you choose." (II. Sure., p. 25, verse 224O 2 

In intercourse between passionately amorous be- 
ings, one of whom is always the leader, there arise 

^loss, Das Weib. Leipzig, 1885, p. 80. 
2 Der Koran ubersetzt v. Dr. L. Ullmann ; Nicolaus v. Tor- 
nauw, Das moslemische Recht. Leipzig, 1855, p. 73. 



PROPHYLAXIS 277 

sometimes habits of certain caresses that might yield 
subjects for contention, and which we choose to des- 
ignate simply as somewhat piquant. The medical 
adviser would do well to dissuade from caresses that 
are rather too piquant, because a man may accustom 
himself to such accessories, and then, when he is re- 
fused them, be impotent for the time. Sapienti 
pauca. 

The most varying opinions prevail in regard to 
copulation during the menstrual period. If we com- 
pare the menstrual period with the rutting season of 
animals, some question is aroused as to the advisabil- 
ity of having coition with a menstruating woman, for 
that period would seem to offer the most favorable 
opportunity for procreation. On the other hand, 
however, it should be stated that most nations ob- 
serve a custom, a religious rule, or a law, that a men- 
struating woman is not to be touched. It is further 
to be observed that some men with sensitive mucous 
membranes may get urethral catarrh. Again, it is 
to be noted that many women are actually sick dur- 
ing menstruation; that coitus with a menstruating 
woman shocks the sense of cleanliness: and, finally, 
that the increase of the population has not been af- 
fected among nations like the Jews and Mohamme- 
dans, where the woman is declared unclean during 
her menstruation and coitus is strictly prohibited. 
Thus copulation may be desisted from during such 
period. 

In recent time much debate has been carried on 
about the hurtfulness of a certain process during 
copulation, which the French have termed "fraud- 
ing." In consideration of the difficulty one meets 



278 SEXUAL IMPOTENCE 

nowadays in providing for a large number of children, 
even married people often feel compelled to accom- 
plish coition with certain precautionary measures 
against impregnation. For this purpose are used 
various means; amongst others, the penis is with- 
drawn just before ejaculation takes place. Only 
he who has no idea of what it means to have eight 
children and little or no bread will contend against 
the justification for these precautions. The use of 
most preventives has no injurious effect on the man, 
and, I venture to assert, no harmful effect on the 
woman. The theory of the cooling of the uterus by 
the ejaculated semen, advanced by Al. Mayer and 
Devay, and discussed with such complacency by 
Bergeret, 1 has no foundation whatever. It is easy 
to convince oneself that the woman during ejacula- 
tion experiences only a pleasant sensation of warmth 
and moisture, and by the use of the usual measures 
of precaution the continued friction of the penis 
against the clitoris and the whole surface of the 
vaginal mucous membrane assists the woman in 
continuing the venereal orgasm to the end. 

The circumstances are far more favorable for the 
man than for the woman when the penis is with- 
drawn the moment before ejaculation. For him the 
erethismus ends with the act of ejaculation, and he 
does not suffer in any way if a smaller quantity of 
sperm is emitted in consequence of the premature 
ceasing of the movements of coition. Matters are 
different concerning the woman : she is sometimes in 
the midst of a most intense orgasmus venereus when 

1 Des fraudes das l'accomplissement des fonctions genera- 
trices. Paris, 1884. 



PROPHYLAXIS 279 

the cessation of the friction occurs suddenly, and this 
may cause disturbances in the nervous as well as in 
the sexual system; for, according to the present state 
of our experience, it must be assumed that the effect 
of an abnormal act is injurious — i.e., if the act has 
not been continued until the satisfaction of the 
sensation produced by the ejaculation is experienced. 
The explanation of this is that if the contraction of 
the muscles does not take place, the genital tube re- 
mains surcharged with blood; the hyperemia sub- 
sides but slowly, and may be the cause of changes in 
the tissue, or a genital derangement. 1 

The statements that Bergeret and others make in 
this respect are probably much exaggerated. I am 
in a position to make the following statements result- 
ing from personal experience. Some women bear 
perfectly any kind of frauding, even the last men- 
tioned, while others very soon become nervous, and 
even have hystero-epileptic fits or suffer from catarrh 
of the cervix of the womb. In contrast with earlier 
experiences, several cases have come under my ob- 
servation in more recent years, in which I found that 
with men also frauding caused some slight neuras- 
thenic phenomena and an injurious effect upon the 
sexual desire. The sudden interruption of coitus is 
not easily borne by passionate men, the individual 
differences, however, being great. It is certainly pos- 
sible that "the bad habit of withdrawal indulged in 
with the object of preventing conception of the 
woman without foregoing the pleasures of coitus" 

1 Krafft-Ebing, Ueber pollutionsartige Vorgange beim Weibe 
Wiener med. Presse, 1888, Nr. n. 



280 SEXUAL IMPOTENCE 

may be one of the causes of prostatorrhea ; but I 
cannot agree with Sturgis 1 when he further reasons 
that because indulgence in coitus interruptus does 
not produce the same satisfaction which coitus does, 
" there is a constant hankering for more intercourse. 
This inordinate desire gives rise to more frequent 
copulation, until hyperesthesia is set up in the pros- 
tatic urethra, which is thought to be relieved by 
more coitus, and thus a vicious circle is established ; 
the more the patient copulates the more the irrita- 
tion, and the greater the irritation the more the de- 
sire for coition." 

My experience in nearly all the cases observed was 
a lowering of the sexual desire in men, and conse- 
quently it cannot be the " over-indulgence in coitus 
which does most of the mischief." 

Bergeret seems to have conceived a pet idea which 
he works out. If a man or woman given to such 
habits is seized by any disease, he attributes it to 
frauding, although every one of the diseases he men- 
tions occurs without any discoverable cause. Berge- 
ret goes so far as to adduce theological reasons against 
frauding. He would deny marriage, and therefore 
copulation, to the poor. In spite of daily experience 
to the contrary, he asserts that a mother of eight or 
ten children looks young in comparison with a woman 
who has for a few years only been addicted to sexual 
extravagances. Bergeret, consulted by unmarried 
women of different ages who, in consequence of fraud- 

1 Sturgis, Prostatorrhea simplex and urethrorrhea ex libidine, 
Journal of Cutaneous and Genito-Urinary Diseases. New 
York, June, 1898, p. 270. 



PROPHYLAXIS 28l 

ing, are declining and suffering from profuse menor- 
rhagia, is able to cure them by advising marriage. 
As if by enchantment they all find husbands, become 
pregnant and well. We can but come to the con- 
clusion that Bergeret rides a hobby, and is ready 
to attribute to the habit of frauding any disease 
observed in a person addicted to it, without taking 
into consideration that all these diseases are to be 
found without any apparent cause. 

In recent years we have learned a great deal about 
the importance of gonorrhea, its complications and 
sequelae as an etiologic factor in several forms of 
sexual impotence. We know that many a case 
which we would have formerly classed as sexual 
neurasthenia is due in fact to pathological changes of 
gonorrheal origin. It is evident that when we 
consider the prophylaxis of sexual incapacity we 
cannot neglect the question of the prevention of 
venereal diseases. I have treated this subject else- 
where, 1 and shall discuss here only the prophylaxis of 
gonorrheal complications, in so far as it is in the 
physician's power. There can be no doubt, that 
whatever good the medical man can do is also his 
duty to do. 

To prevent many cases of premature sexual im- 
potence and consequent great misery, every physi- 
cian must give proper care to every single case of 
gonorrhea that comes under his observation. 

In order to be able to do anything properly it 
must be learned how, and therefore we must be glad 

1 Vecki, The Prevention of Sexual Diseases. Critic and 
Guide Co., N. Y., 1910. 



2%2 SEXUAL IMPOTENCE 

to observe that even the so very dignified faculties 
of some of the more prominent medical schools begin 
to see, and what is more important, to acknowledge 
that medical students ought to learn more about 
sexual diseases than what has been the custom until 
very recently. 

It would lead us too far to enter into any details 
about the treatment of gonorrhea, and we shall 
therefore mention only a few of the fundamental 
and irrefutable principles. 

Above all, that guiding law in the treatment of all 
disease: " non nocere!" must never be forgotten. No 
matter what the temptation may be, no matter what 
urgency the impatient patient may plead, never shall 
the physician attempt anything that he is not abso- 
lutely sure will do good and no harm. No treatment 
is better than ill-treatment. In this respect physi- 
cians with little or no experience in the handling of 
gonorrhea will sooner be apt to act energetically and 
undertake therapeutic measures which the specialist 
would never dare to think of. 

On the other hand, we must be glad, that the sense- 
less prejudice, that the gonorrheal discharge must 
not be attacked during the first and acute stage of the 
disease, is being gradually abandoned. When we 
know that a most dangerous germ is destroying the 
mucosa of the urethra, it is hard to understand why 
it should be left undisturbed. My method of attack- 
ing gonorrhea at once with a half per cent, solution 
of the best obtainable medicinal f uchsin is very effec- 
tive and absolutely harmless. Of course, if we should, 
by foolish attempts at aborting the disease, accom- 



PROPHYLAXIS 283 

plish in a short time what it takes the gonococcus a 
long time to do ; when by the action of a strong solu- 
tion of any kind we destroy the upper layers of the 
mucosa, then we may destroy a large number of the 
invading microbes, but we also prepare an excellent 
field for the surviving ones. Therefore we must add 
to the old non nocere another warning : do not inflict 
undue pain upon your patient ! Any treatment in an 
inflamed urethra is painful to a certain degree, but 
any treatment that causes a great and lasting pain 
certainly has done no good whatever. Thus, a 
patient who leaves a physician's office in agony and 
suffers for hours, and sometimes for days, from the 
energetic treatment of too brave a therapeutist, has 
only been damaged. The anatomically complicated 
urethra cannot be treated as if it were a simple 
rubber tube that can be disinfected ad libitum. And 
a physician who creates conditions to perpetuate the 
gonococci in anyone's urethra certainly does not do 
his duty toward prevention of sexual impotence and 
prevention of venereal diseases in general. 

A great deal could be accomplished if we could 
succeed in persuading our patients that they are 
really sick when they come to us with a fresh and 
acute attack of gonorrhea. If they could be per- 
suaded to go to bed as sick people should, to have 
absolute rest, observe a strict diet, be purged and 
treated very, very mildly, most cases of gonorrhea 
would be cured in the shortest time. Unfortunately, 
people joke about gonorrhea, trifle with it, allow it to 
become chronic, acquire complications, waste time 
and money and regret all this when it is too late. 



284 SEXUAL IMPOTENCE 

And many a physician would have a clear con- 
science if he just knew that any solution which could 
not be applied to a person's cornea has at no time any 
business in anyone's urethra. The vis medicatrix 
naturae must never be forgotten. Nature works in- 
cessantly to fight and to expel the previously killed 
microbes, but the natural powers are not able to act 
when the gonococci have been given a chance to hide 
in the deeper layers of the mucosa, in cracks, minute 
follicles and in glands. 

The acute and inflammatory stage of gonorrhea 
should not be considered as being unworthy of the at- 
tention of the most prominent urologist, while infil- 
tration, fibrillous and callous degeneration are often 
incurable, or yield only to the skilfully applied knife. 

It is now generally claimed that the medical profes- 
sion, and to some extent also the public at large, have 
awakened to the realization of the seriousness of 
specific infections of the urethra and its many pos- 
sibilities and consequences. The old prejudice, 
however, that to treat yonder trifle, commonly called 
"clap," is something beneath the dignity of a great 
physician, is still very much alive. Else how were it 
possible that the number of practitioners who pre- 
scribe perfunctorily upon the patient's self-made 
diagnosis of gonorrhea hardly ever grows less, and, 
though censured so frequently, it is still considered 
superfluous to pay proper attention to the selection 
of the syringe and instruction of the patient in its 
use whenever injections are advised? And what is 
even more significant, how were it possible that our 
most renowned genito-urinary surgeons, the great 



PROPHYLAXIS 285 

men, those with an international reputation, very 
seldom condescend to treat acute gonorrhea? 

In opposition to the many who think that acute 
gonorrhea is not worth while treating are the fellows 
who jump at it with enthusiasm and cum furore, as if 
they were bound to destroy the patient's natural 
defences and to help the gonococcus to penetrate into 
the deeper layers. 

Toward the end of the seventeenth century Lalle- 
mand published his famous work "Pertes seminal es" 
and reported his brilliant and prompt results ob- 
tained in various ailments, including what we would 
term now sexual neurasthenia, by means of a cauter- 
ization of the caput gallinaginis with a lapis stick or 
caustic holder that formed part of a specially con- 
structed instrument. 

Lallemand was the inventor of his method, he saw 
the results in a rosy light, reported on them enthusi- 
astically; there was no one with authority to con- 
tradict him, no one to criticise or hurt him ; he became 
famous. Is there any wonder that his success and 
glory disturbed the peace of mind of many a urologist 
in the nineteenth century? And so Dittel came with 
his porteremede, Ultzmann, Guyon and others with 
their deep urethral syringes, and up to this time 90 
per cent, of physicians are armed with some such 
appliance, and whenever an unsuspecting patient's 
morning drop does not disappear swiftly it seems to 
be the duty to introduce some kind of an instrument 
into the deep urethra, and flood it with a solution that 
burns like the everlasting fire and makes a splendid 
impression upon the sufferer, who consoles himself by 



286 SEXUAL IMPOTENCE 

saying, "Now, that ought to cure!" When in conse- 
quence the conditions become worse, the discharge 
more copious, there is another consolation ready, 
" The strong injection is bringing it out. " 

And how can we expect that the average physician 
shall have pity on his fellow-man's urethra when the 
highest authorities still preach the gospel of burning? 
While Zeissl mercifully does not go beyond a i per 
cent, nitrate of silver solution, Frisch goes from 2 to 5 
per cent, nitrate of silver and 3 to 5 per cent, of sul- 
phate of copper. Keyes thinks "It is not wise to 
use the nitrate stronger than 5 per cent, for fear of its 
caustic action." Wisely he adds that "Even that 
strength often produces a temporary intense irrita- 
bility of the bladder with bloody urine." 

Our great master Neisser begins to see that "the 
continuance of irritating injections favors the growth 
of the gonococcus by maintaining serous infiltration 
of the urethral mucosa," and it were a blessing if 
he left out the word " continuance." 

Besides, what does any one expect to accomplish 
by applying a few drops of any kind of a solution to 
the deep urethra when all kinds of germs have crept 
into urethral glands whose ducts would surely not 
absorb the slightest particle of the fluid even if they 
were not partly or completely plugged ? It would be 
laughable were it not so painful to so many poor 
fellows under treatment, and besides so deucedly 
harmful. 

Whoever handles the various diseases of the 
genito-urinary organs to any extent will bear me out 
in the statement, that the number of patients dam- 



PROPHYLAXIS 287 

aged by various manipulations in the urethra is 
enormous. The injury is mostly done by inexperi- 
enced hands, but often enough by operators trained 
to a mechanically perfect technic. 

This time I have no intention of considering the 
criminal side of the question, the shady transactions 
of the quack and the charlatan, but only intend to 
discuss a few of the so-called legitimate and generally 
accepted therapeutic measures which in reality are 
most glaring and most common sins against the 
genito-urinary organs. It may not be out of place to 
mention right from the start that I do not think I 
can be entitled to a stone-thrower's license, and that 
the arraignment is directed solely against thoughtless- 
ness and heedless copying and perpetuation of old 
practices. 

One of the most popular instruments is the urethral 
sound, and it is certainly a conservative statement 
when I claim that it is used ten times oftener than 
really necessary. While it surely ought to be re- 
served for those who actually need it, there is no 
harm done if a sterile, properly lubricated sound of 
proper size is correctly introduced. 

As we do not intend to discuss the criminal side of 
the question, we do not have to contemplate the 
introducing of a sound that was not previously 
sterilized by heat ; we almost could pass by the creat- 
ing of false passages, were it not that it happens so 
frequently and that it so banefully complicates cases 
of strictures in the posterior urethra and of prostatic 
hypertrophy. 

False passages are almost invariably done with 
solid, fine-calibered and pointed instruments in the 



266 SEXUAL IMPOTENCE 

hands of operators who use force and lack the higher 
sensitiveness of their Pacinian bodies. 

One of the most common sins against the urethra is 
the forcing of the passage of an instrument whose 
caliber is too large. To determine the size of a sound 
to use is not always so easy. The meatus may be 
misleading in either direction, and a mistake is easily 
made. The patient will frequently object to any 
size, and if too large an instrument was selected it is 
by far better to pocket the slight humiliation of the : 
" I told you it is too big," than to lacerate the urethra. 

The progress made in urology and principally in the 
therapy of the various diseases of the urethra due 
to the various urethroscopes is certainly gratifying, 
but the instrument fairly useful in expert hands is 
very dangerous if used without discretion, and is 
responsible for many a laceration, followed by deep- 
layer infection and scar formation. An example 
to what aberrations it may lead is the ultra scientific 
method which was recently proposed as "a quicker 
and better way to remove the top of the hypertrophy 
of the Verumontanum with the sharp edge of the 
deep urethral tube." 

It would take a good-sized volume to do justice to 
the subject, of what should not be done to the genito- 
urinary organs ; it will surely be written by some one 
sooner or later, and as I have may be said too much 
already, I beg the privilege before finishing of a few 
questions. 

What does the man who irrigates the gonorrheal 
posterior urethra with the aid of a catheter expect, 
unless it is an acute prostatitis? 



PROPHYLAXIS 289 

How is it possible that with our present knowledge 
of the bacteriologic flora of the urethra so many still 
dare to introduce instruments into and even dilate 
it without irrigating before and after? 

And if the average practitioner waits until urinary 
symptoms develop before anything is done for a 
stricture, and thus, as V. C. Pedersen of New York 
recently emphasized, prevents timely treatment of 
many cases, why not wait with a stricture in the 
esophagus so long as the patient can swallow liquids? 

By the way, does it not seem to you that some of 
the good results accomplished, when the energetic 
and enthusiastic therapeutist turns from local treat- 
ment to vaccination, are due to the rest given to the 
urethra while the hide is being belabored? I am 
sure that still better results will be obtained if the 
advice just now coming from London to combine 
vaccination with a bland diet, plenty of fluids and an 
absolute rest in bed is strictly followed. 

My suggestions are : 

When a physician is confronted by any case of 
disease, and more especially before rushing into any 
one's urethra with iron and fiery solutions to tear and 
to burn, he ought to remember the golden rule, and 
ask himself what he would wish were done for him if 
he were in the patient's place. Economic conditions 
are such that it is asking too much that the physician 
should consider also the question: Would he, if 
inflicted by a like ailment, seek the advice and help 
at the hands of a man of his own experience? It 
would be a great progress, however, if everybody, 
and if I say everybody I admit of no exceptions, 
19 



29O SEXUAL IMPOTENCE 

would at all times remember that to do for any patho- 
logical condition little or even nothing is far better 
than to do actual harm. 

Whoever has witnessed the rage and despair of the 
victims, whoever has given the subject proper con- 
sideration, and scanned his own past experiences, 
must come to the conclusion that mild and painless 
treatment may cure, and invariably gives good re- 
sults, while the energetic, merciless handling of the 
urethra invariably does damage only. 

The study of modern works on psychanalysis 1 
teaches us that a rational education of children may 
prevent many a case of compulsion neurosis, ob- 
session, doubts, phobias, homosexual and other 
pervert wish phantasies; also that parents should 
be most careful with only and with favorite children 
in order to avoid the "unconscious parental in- 
fluence ' ' and the sometimes ensuing so-called ' ' CEdi- 
pus' complex." 

1 For instance: Brill, Psychanalysis, Saunders, Philadelphia and 
London, 19 14. 



CHAPTER VIII. 

TREATMENT. 

Impotence is mostly difficult to cure, and some- 
times incurable. The great number of methods and 
remedies recommended speaks for the small value of 
most of them; and yet there is hardly any one of 
them that could be entirely dispensed with, because 
there are cases in which the one or the other may be 
of some use. 

The treatment of impotence, this many-headed 
hydra, varies according to form, phenomena, and 
state. The treatment of one form of impotence 
varies in regard to stage and accessory phenomena, 
and the remedies must be changed frequently before 
one can obtain a cure. One and the same remedy 
has not an equal effect on all men; allowance must 
be made for, or due attention paid to, idiosyncrasies 
of the patients, who are most of them neurasthenics. 

In the choice of any therapeutic measure we must 
take into account everything — the state of the sex- 
ual organs and general bodily conditions, the time 
taken by individual metabolism, age, habits, occupa- 
tion, and manner of living. Often the system accus- 
toms itself to a remedy and renders quite inoperative 
one that had formerly done favorable work. 

The success or failure of a treatment depends on 
the choice of the remedies, and in order to be able to 
choose the proper one in a given case the physician 

291 



292 SEXUAL IMPOTENCE 

must, first of all, have a great amount of experience 
in that direction; he must make his examinations 
with great care and employ much ingenuity. In 
order to secure a prospect of success, he must, in the 
first place, gain the confidence of his patient. The 
impotent and the sexual neurasthenics, as a rule, 
approach the medical man with little hope and con- 
fidence. To this is added false shame, which makes 
them very reserved. Most physicians care little 
for such patients, and therefore dismiss them after 
a superficial examination. This will not help to 
increase the hopefulness and confidence of the 
patient. In order to win this the physician should 
at least show a certain degree of interest and sym- 
pathy. He must question his patient very closely 
and examine him equally carefully. This is neces- 
sary for the diagnosis alone. 

If the physician inspires the patient with some 
courage and confidence, he has by that means taken 
the first step in the treatment, because every impo- 
tent person must first of all be treated psychically. 
As soon as such a patient has once conceived some 
hope for his curability and confidence in the physi- 
cian he shows himself an exemplary patient and will 
subject himself to any treatment. Nothing is too 
difficult, nothing too disagreeable, nothing too pain- 
ful. Even individuals who are very much reduced 
in strength and energy, in consequence of onanism or 
pollutions, are no exception in this. I emphasize 
this expressly in contrast to Lallemand's 1 statements, 
which may have been correct, because in his time 

1 Lallemand, op. cit., tome iii, pp. 129 and 131. 



TREATMENT 293 

the sick had more cause to fear medical men and 
their methods of treatment. 

In case the physician should discover some of the 
causes of impotence still in existence, he must remove 
them as speedily as possible. Often the impotence 
disappears with its causes ; but at any rate there can 
be no question of any treatment for impotence before 
the causes are removed. 

The methods for treating impotence are manifold, 
as already stated. There is a general and a local 
treatment; the application of medicaments, hydro- 
therapeutics, electricity, massage, etc. Each one of 
these groups comprises many single methods and 
remedies. In the treatment of a disease that is so 
difficult to cure we must make use of every means at 
our disposal, each remedy being applied at the indi- 
cated moment and opportunity. It goes without 
saying that a mere excitation of the genitals or their 
nerve-centers which would be but transitory in its 
effect, and would not at the same time have the ten- 
dency to strengthen them, can never be the object of 
a rational and conscientious therapy. 

We shall now discuss the single curative methods, 
and conclude with the discussion of the therapy 
for every state of impotence. 

Psychical treatment is indispensable in every form 
of impotence excepting the organic. Psychical 
treatment forms in some measure the introduction 
and beginning of every other manner of treatment. 
It has been stated above that first of all the physician 
must conquer the hopelessness and distrust of his 
patient. Fear alone prevents in many cases the 



294 SEXUAL IMPOTENCE 

accomplishment of a successful sexual act. To take 
that fear away, to restore the patient's self-confidence 
constitutes a cure in many a case of sexual neuras- 
thenia. This is frequently very difficult of accom- 
plishment, particularly with patients who have al- 
ready engaged in the study of several so-called popu- 
lar scientific works, and with the greatest difficulty 
with patients who happen to be medical men. I 
have had many an opportunity to treat neurasthenic 
physicians for impotence ever since the appearance 
of the first German edition of this work. I met, 
without exception, with nearly insurmountable diffi- 
culties. It takes a great deal of experience to use 
the proper arguments, drugs, or even tricks to per- 
suade the so-called psychically impotent who has 
his own sad experience to contradict mere encourag- 
ing words. 

The next step is to induce the patient not to think 
continually of his disease. For this purpose those 
who are impotent or believe themselves so should en- 
deavor to find various distractions. They should be 
recommended any kind of pastime which involves 
some bodily exercise; such, for instance, as some 
suitable occupation that is not fatiguing and is at the 
same time attractive — driving, riding, theaters, con- 
certs, balls, gymnastics, fencing, swimming, skating, 
bicycling, rowing, pleasant journeys of moderate 
duration, etc. 

The patient should be most strictly forbidden any 
useless sexual excitement, reading of lascivious books, 
contemplating piquant pictures, and so-called mental 
onanism. Persons who have experienced a repeated 



TREATMENT 295 

fiasco with women are in the habit, before they pro- 
ceed to coition, to excite themselves sexually in sun- 
dry ways in order to prepare themselves for the act ; 
but they regularly find that the result is the very op- 
posite to what they had in view, and this introduc- 
tory excitement is often the cause of impotence. 

The patient must be told not to allow single fail- 
ures to affect him too gravely, but to look upon them 
with more indifference, and treat them as casual 
mishaps. It is not uncommon that virility returns 
with the peace of mind, while erection will not appear 
when it is most ardently wished for. This is a reason 
for the well-known fact that young husbands who 
fancy they are impotent are often cured by the mere 
forbidding of coition. The object is to re-establish 
mental composure, with which often comes the erec- 
tion also. 

A physician must never suppose that it is possible 
to put an end to impotence by simply denying it, 
even were it but a so-called psychical impotence. If 
the physician denies facts that have been experi- 
enced by the patient, he simply loses the latter's 
confidence irrevocably. Frequently medical men 
are led to believe they have to deal with a case of 
hypochondria, when upon investigation they find 
they have made an error in diagnosis. Hypochon- 
dria is a very rare disease, and exists without any 
reason or cause whatever only in persons of unsound 
mind, and even then such mental disturbance is 
itself the cause of the hypochondria. 

A therapeutic procedure that has enthusiastic sup- 
porters, but also many bitter opponents, is hypno- 



296 SEXUAL IMPOTENCE 

tism, by which real miracles are sometimes accom- 
plished, in spite of statements to the contrary. 

I have personally obtained very good results in 
several cases that were suitable for such treatment, 
though I was never able to place any of my patients 
in deep hypnosis. The hypnoidal state (Sidi's) is 
quite sufficient in most cases. One should, how- 
ever, always be guarded against self-delusion. In 
the treatment of psychical impotence suggestion is, 
indeed, the means without which we can expect but 
little result ; and from suggestion to hypnotism there 
is only one step. 

Bernheim 1 was able to influence menstruation by 
hypnotic suggestion. Krafft-Ebing 2 wrote thus: 
" The task of posthypnotic suggestion is in such cases 
to suggest a dissuasion from the impulse to commit 
masturbation; to create, by suggestion, a feeling 
against homo-sexual desires; to induce a conscious- 
ness of virility, and to arouse heterosexual desires." 

Baron v. Schrenck-Notzing related one of his cases 
that beautifully illustrated the therapeutic power of 
suggestion. Another case may be mentioned, that 
of Tessie quoted by Casper. Many cases of neuras- 
thenia have been cured by hypnotic suggestion. 
Berillon reported more than twenty-two cases of 
nocturnal incontinence of urine, and four cases of 
irresistible onanism in children. 

When all of this is considered, we may justly ex- 
pect hypnotic suggestion to prove to be a powerful 

1 De la suggestion. Paris, 1888, pp. 557~5 6 3- 

2 Psychopathia sexualis. Stuttgart, 1890, p. 225. 



TREATMENT 297 

remedy in onanism, morbid pollutions, and various 

forms of impotence. 

My experience with Freud's psycho-analysis and 
similar methods is decidedly encouraging. I shall 
quote verbatim a short report on psychotherapy 
which Albert Abrams was kind enough to write for 
this edition : 

"There has been a tendency of late to subdivide 
the neuroses, and a new mental disorder, psychasthe- 
nia, has been added. 

"The psychasthenic state is often confused with 
neurasthenia and hysteria. Thus hysteria is associ- 
ated with suggestibility and neurasthenia with 
fatigability. 

" The phobias and obsessions are not neurasthenic, 
but psychasthenic symptoms. 

" In psychasthenia, the symptoms are periodic and 
anything which diminishes the general vitality, 
causes a recurrence of symptoms. 

"In a word, psychasthenia refers to the formerly 
recognized mental symptoms of neurasthenia without 
the fatigue of the latter affection. 

" I employ the neologism, ideopath to designate an 
individual whose apparently sole affliction is some 
morbid idea. His idea reacts on the feelings and 
becomes a source of acute suffering. 

"Freud's method of psychotherapy is difficult of 
application and is only of value in individuals with 
a certain degree of character and education. 

"Poor results are attained in neurotic degenerates. 

"All hysterical and psychasthenic conditions are 
amenable to this method which is based on the sup- 



298 SEXUAL IMPOTENCE 

position that hysteria can be traced to unconscious 
fixed ideas, and that by translating the unconscious 
to the conscious, the impulsions which dominate the 
patient may be eliminated. Freud contends that a 
sexual factor is responsible for the hysteria and that 
the factor in question arouses an emotion which is 
associated with some bodily or verbal expression. 
The original emotion may pass from view, but 
the expression of the emotion lives and recurs in 
consciousness. 

"Freud's method is as follows: 

"The patient must completely relax in a suitable 
environment, and with all sense stimuli excluded. 
With the hand on the patient's brow the patient is 
urged to search the memory for any forgotten painful 
experience, notably that implicating sex. This 
method must be repeated several times. 

"According to the Freudian conception, our 
conscious personality is the result of continuous 
growth. 

"The child is primitively savage and by degrees 
only he adapts himself to the restraints of civilization 
and represses his old activities. The repressed ac- 
tivities, however, leave their traces even though they 
do not affect us consciously, and this is particularly 
true in the realm of sex. Now the child has its own 
sex life (although not expressed in the sexual organs) 
in a manner which in the adult would be regarded as 
perversions, and, if not repressed give rise to the 
perversions in later life. Although such original 
means of sexual gratification are inhibited by envi- 
ronment and other influences, yet the tendency to 



TREATMENT 299 

their enjoyment appear in many ways, notably in 
dreams. During sleep our inhibitions are relaxed 
and the repressive force is not great, hence the fac- 
tors making up the primitive sexual life emerge into 
consciousness and are expressed in dreams. Thus it 
is, that the motive force behind a dream is always 
some old complex in the depths of the soul." 

Dr. Carl Renz of San Francisco says in a personal 
communication : 

" The psychic form of impotence is the most com- 
mon of all troubles in this category 

"Psychogenic impotence is a symptom seen occa- 
sionally in perfectly healthy individuals, but very 
frequently in sexopathologic conditions. This symp- 
tom is due to ideas or conceptions interfering with 
the psychical and physical conditions necessary to 
accomplish the sexual act. The center of erection is 
inhibited through disturbing or contrary ideas. 
The majority of cases are among neurotics and 
psychotics 

" Others, especially impressionable, timid or doubt- 
ing people or such with little or no self confidence are 
liable to be impotent. Unpleasant memories, worry, 
sadness, disgust, fear of ridicule, aesthetic considera- 
tions are also frequent causes of this inhibition. 
Sometimes the impotence is apparent only when 
intercourse with a certain woman is attempted; 
more frequently, however, it is general. 

"Among the treatment of these sexual disturb- 
ances due to psychic causes, psychotherapy occupies 
the most prominent place. Good results have been 
reported in cases treated by spermin injections and 



300 SEXUAL IMPOTENCE 

in corresponding cases in women with the use of 
ovarian extract. The words spermin and ovarian 
extract are strongly suggestive, and I believe that 
the benefit derived from organotherapy in these cases 
is due to suggestion. 

" Approximately 60 per cent, of the cases treated 
formerly with hypnosis were cured. In more recent 
years the results are better yet. 

"Since we know that dormant or forgotten com- 
plexes, attended by an emotional tone inhibit the 
process of coition, the methods of resurrecting these 
ideas out of the unconscious have proven to be very 
successful and have added greatly to improve the 
prognosis. There are different methods; the technic 
may differ, but they are practically alike and their 
fundamental principle is suggestion. When the 
original experience which caused the trouble cannot 
be recalled voluntarily, artificial means are used, e.g., 
Freud's psycho-analysis, analysis in Sidi's hypnoidal 
state, in hypnosis, by automatic writing or by the 
word association method." 

Among Renz's many clinical histories plainly illus- 
trating the results of psychotherapy in many cases 
where other therapeutic measures have failed, we 
shall report only one: 

"Man about thirty, single, complained of impo- 
tentia cceundi for two years, cause unknown to him. 
Physically normal he presents psychoneurotic 
symptoms. Analysis in the hypnoidal state unveils 
the following history: Three years ago the patient 
was caught in a compromising attitude with a 
woman, this produced such a shock that he refrained 



TREATMENT 3OI 

for some time from sexual relations, 'the mere 
thought of it made me feel faint and sick in the 
stomach,' he said. When he resumed his former 
mode of life again he found himself unable to per- 
form the act, but did not attribute the cause to the 
psychic trauma, and therefore, when questioned 
about the origin, when the anamnesis was taken, 
did not mention it. 

"After explaining the association between the 
psychic trauma and his impotence he soon regained 
his former power." 

Consciously or unconsciously, psychotherapy is 
being employed by every physician. The methods 
are old; only the names are new. For the most 
part the methods have been rather crude, and who- 
ever, prompted by his personal experience, tried to 
give some variation of psychotherapy great impor- 
tance in his own practice was sure to be called a 
faker, an imposter. But some of the imposters and 
fakers were successful with many patients. The 
medical profession at large, however, sitting on its 
dignity, clad with periwig, doctor's hat and stick, 
or later under the atavistic influence of these signs 
of an exclusive rank, refused to take notice. It is 
humiliating, but nevertheless true, that among the 
fakers a female prophet had to arise, to compel the 
medical profession to start an investigation and to 
examine one of the most powerful weapons in the 
fight against disease and suffering. 

The representatives of urology may deem them- 
selves safe from the encroachments of the various 
aberrations of the many groups of mental healers. 



302 SEXUAL IMPOTENCE 

No amount of prayer will melt a stone in the bladder, 
nor will it arrest tubercular and other structural 
changes and their consequences in these organs; 
and so on with variations. But, how about the 
many thousands of sufferers who haunt the various 
offices and whom the prosperous urologists refuse 
to handle and others administer to with such scant 
results? How about the many who have had their 
prostate massaged, their urethra irrigated ad nau- 
seam, dilated, burned, lacerated and otherwise mal- 
treated, and who remain in the same or in a worse 
condition than they were when they came to seek 
help? Who can remain obdurate and refuse to 
acknowledge that something is radically wrong? 

Of course, wherever the modern methods of 
urology are indicated, psychotherapy will have to 
be relegated to the furthest background, but it 
can very seldom be eliminated altogether. Psycho- 
therapy is not going to replace the irrigator, the 
sound, the dilator, the knife, the endoscope, the 
cystoscope, nor any other of our almost perfect ap- 
pliances. Urology, now in the foremost rank of 
medical specialties, does not have to pause in its 
onward march to the position of the most exact 
branch of medical science, but it will certainly only 
add to its tremendous usefulness by adding sys- 
tematically studied psychotherapy to its armamen- 
tarium. 

The number of patients applying at the urolo- 
gists' offices is growing all the time, and the num- 
ber of those amongst them who cannot be cured 



TREATMENT 303 

without the help of properly employed psychother- 
apy is considerable. 

Since 1888 I have kept on using and advocating 
psychotherapy. At first I thought its usefulness 
was limited to those suffering with sexual neuras- 
thenia, but when newer methods and means of ex- 
amination began to thin the ranks of the functional 
diseases of the genito-urinary organs, it became 
obvious that psychical treatment must form, in 
some measure at least, the introduction and begin- 
ning of every other manner of treatment in most 
cases of the diseases we have to deal with. 

The subject of psychotherapy in urology is im- 
mense; and I shall endeavor to formulate a few 
rules that my experience has taught me to adopt. 

Cases of genito-urinary diseases, like diseases in 
general, must be divided into four groups : 

1. Diseases of the mind itself. 

2. Diseases of bodily organs overregistered by a 
diseased mind. 

3. Diseases of bodily organs overregistered by a 
healthy mind. 

4. Diseases of bodily organs rightly interpreted 
by a normal mind. 

In the first group psychotherapy alone will cure 
if cure there be. In the second group psychotherapy 
will have to take the leading part in the treatment, 
in the third group the minor part, and may be of 
little, if any, importance in the fourth group. 

Whoever intends to use psychotherapy must take 
his time to individualize and to study every single 
case. Jumping at conclusions most frequently leads 



304 SEXUAL IMPOTENCE 

to errors, but the psychotherapist must not get dis- 
couraged when he finds himself on the wrong track. 
Things are not always quite simple, and whoever 
is in a hurry can accomplish nothing. 

Every case must be approached with sympathy. 
The physician who cannot love his patient, and 
cannot impress his patient with the feeling that 
he really sympathizes with him, cannot gain his 
confidence and will surely fail in any psychothera- 
peutic endeavor. 

Patience is one of the most important require- 
ments,'^ as in many cases results can be obtained 
only by degrees, and whoever attempts too much at 
one time, or even loses his temper, loses ground at 
once. 

Some so-called neurasthenics can be influenced by 
a simple talk, an explanation of symptoms and con- 
ditions, by persuasion and suggestion; others must 
be taken through the intricacies of re-education, 
psycho-analysis, or even placed into the hypnoid 
and, if possible, the hypnotic state. 

Personally I was never able to place any one into 
a spectacular hypnotic or even cataleptic trance, but 
while not denying the possibilities in this direction, 
I only claim that a hypnoid condition is all that is 
necessary in order to obtain the very best results. 
While we must always individualize, it can be stated 
in general that the two extremes, the highly edu- 
cated, scoffing skeptic and the illiterate ignorant who 
never heard of psychotherapy, must be placed in one 
class, and must never be told that psychotherapy is 
going to be used upon them. Such people are best 



TREATMENT 305 

treated in the evening, in a darkened room where all 
noises can be excluded. The patient is given high- 
frequency or an autocondensation treatment. The 
dim light of the apparatus, the muffled and monot- 
onous sounds of the motor are a valuable intro- 
duction to get the patient under influence; finally 
he is either told to close his eyes or ordered to gaze 
upon the high-frequency electrode through which 
only very weak currents are passing. Talking to 
the patient in a gradually lower and lower tone of 
voice, more and more monotonously, soon brings the 
subject into that hypnoidal state in which any sug- 
gestion will create lasting impressions. 

People of a lively or flighty temperament who 
are not so easily influenced should be ordered to 
take a long walk or some fatiguing exercise, eat a 
substantial dinner, and even to take a moderate 
amount of alcohol before the time of treatment; I 
never found a narcotic to be necessary. 

Tactual manipulations are very seldom indicated, 
and must always be avoided when a homosexual 
individual is under treatment. 

There is no necessity of testing the degree to which 
a patient is under the influence. An impatient 
operator, by giving orders which the subject is able 
to resist, loses even the small influence he might 
have had. One must always be satisfied with what- 
ever can be accomplished at any single sitting, 
because the next time surely more will be possible. 

Many physicians make the mistake of judging 

their patient from their own personal standpoint. 

The psychotherapist, however, can accomplish noth- 
20 



306 SEXUAL IMPOTENCE 

ing unless he succeeds in placing himself mentally 
into his subject's condition. No statement, no 
matter how improbable or even impossible the feel- 
ings it may describe, should be disbelieved or, what 
is worse, ridiculed. The patient really feels what 
he says he does, and if his statements are absurd 
and foolish he must be the first to laugh at them, 
and then the physician may join him. 

We know nothing about the soul, but what we 
are used to call by this name, the person's mental 
make-up, "his nature that is characterized by the 
attributes of self- consciousness, conscious personal 
identity, reason, conscience, and the higher emo- 
tion," is his own, no matter what civil or ecclesi- 
astic authorities and law-makers may say. 

We surely agree with Miinsterberg, who claims 
that every physician and even the village doctor 
needs psychotherapy much more than he needs the 
knife and the electric current, but I think he over- 
estimates the value of a systematic study of psy- 
chology, as a condition sine qua non for the psycho- 
therapist. Psychology, no doubt, should be studied 
by every one who wishes to become an educated 
man, and uneducated people should not be admitted 
to the study of medicine; but psychotherapy is 
mostly done without much theoretic psychology, 
and is invariably based upon proper reasoning, sup- 
ported by experience and a thorough knowledge of 
human nature, which, after all, is practical psy- 
chology. Of course, anyone attempting psychother- 
apy must understand the laws of association of 



TREATMENT 307 

ideas in so far as they can be formulated and under- 
stood. 

The psychotherapist, however, must never forget 
the fact that matter must last and cannot disap- 
pear, but that the products of our mind, the ideas, 
volitions and emotions, our joys and sorrows, must 
always be born anew, and are doomed to disap- 
pear. And so long as all the products of the human 
mind conform to this rule all is well ; but when one 
of them gets undue preponderance over all the 
others, and refuses to disappear, even to weaken 
and yield to others, then it is time for the psycho- 
therapist to step in. 

Tedious cases are frequent, slow progress, set- 
backs and even relapses must be expected; but the 
physician who uses rational psychotherapy never 
need throw up his hands, or utter a sigh of relief 
when the patient finally stays away or changes 
physicians. 

Psychotherapy excludes no other rational treat- 
ment, and therefore, to adapt what Mtinsterberg 
emphasizes in general, I would say: The urolo- 
gist must be much more than a psychotherapist, but 
whatever else he may be, he must also be a psycho- 
therapist. 

As the principal aim of psychotherapy ought to 
be removal of symptoms, it is clear that in urol- 
ogy, while very valuable and often indispensable, it 
can mostly be a helpmate only, very seldom the 
whole. 

We have already said that any existing cause of im- 
potence must first be removed before the treatment 



308 SEXUAL IMPOTENCE 

of the impotence itself can commence; organic ob- 
stacles must, if possible, be removed by surgical oper- 
ation; diseases causing impotence should be treated 
appropriately; special attention to be paid to the 
treatment of oxaluria, obesity, anemia and the var- 
ious forms of neurasthenia, while diabetics can, as a 
rule, only be helped by mechano-therapeutic meas- 
ures. Onanists must be cured of their habit, and 
proper remedies applied in case there is sperma- 
torrhea, pathological irritation, or a condition of 
weakness in the genitalia. 

We have mentioned the prophylaxis of onanism, 
and shall here but warn against heroic and danger- 
ous remedies. Mairet and Ardin Delteri, for in- 
stance, recommend hyoscin subcutaneously one- 
fourth to two milligrams pro die. Hyoscin paralyzes 
the genito-spinal center, and the danger of a lasting 
damage is hardly compensated by the benefit that 
can at best be only temporary. 

We shall devote a more detailed discussion to the 
treatment of spermatorrhea, because spermatorrhea 
is frequently the sole cause of impotence, and plays 
an important part in nearly every case. The treat- 
ment of spermatorrhea is truly in a lamentable state. 
The first increase in the frequency of pollutions is 
scarcely ever treated rationally, because the patient 
either does not mind it, or avoids consulting a 
physician about it from false modesty, or, finally, be- 
cause he finds that his doctor neither understands 
his ailment nor even listens to his story. Yet one 
needs no demonstration in order to see that it is of 
the utmost importance that spermatorrhea should 



TREATMENT 309 

be combated from its very beginning. In our prac- 
tice we often discover what desperate efforts are 
made by the patient in his struggle against the con- 
stantly increasing frequency of the pollutions; what 
unreliable remedies are adopted, and how the body 
is chastised; or how every enjoyment, every comfort, 
is denied oneself, everything is tried that has been 
mentioned or praised by physicians, friends, and 
books as being of good effect in the case in question. 
Many a remedy or measure seems at first to have 
some good effect, but sooner or later loses all efficacy. 
Meanwhile the precious time passes and the pollu- 
tions grow worse. Lallemand 1 tells of some exam- 
ples that are really characteristic and are taken from 
life. 

The treatment of spermatorrhea is a very delicate 
and difficult affair. It engages in its service nearly 
all the therapeutic remedies and expedients which 
find their application in the treatment of impotence, 
and of which we shall speak later on. Thus it in- 
cludes in some special cases the use of medicaments, 
hydro-therapy, electro-therapy, and local endoscopic 
treatment. 

As a matter of course, we must in the first place 
search for the etiological factor, so that it may be re- 
moved as soon as possible. Onanism, which is the 
most frequent cause of spermatorrhea, must be con- 
sidered at once. Besides this, a phimosis, if such ex- 
ists, must be corrected by surgical operation, even if 
it is not of a high degree. Phimosis is oftener the 
cause of persistent pollutions than one would think, 

1 Pertes seminales, tome i, pp. 294-304. 



310 SEXUAL IMPOTENCE 

because by pressure it irritates the member, even 
when slightly erected; and, besides, the phimosis, by 
protection, renders the glans over-irritable and sensi- 
tive. A very good method for the radical removal of 
any superfluous part of the prepuce has been de- 
vised by G. Marion 1 . 

Regulation of the manner of living will present spe- 
cial difficulties. An individual suffering from pollu- 
tions must in the evening abstain from food not 
easily digested; he must not eat any spicy dishes, 
and in general special attention and watchfulness 
must be directed to the food and the increase of the 
activity of the digestive organs. The patient must 
take his supper at least three hours before sleep, and 
he must before he goes to bed empty his bladder, and 
at all times care for regular defecation. He must 
sleep on a couch or bed moderately, but not too 
hard — best on a horse-hair mattress. My observa- 
tions have taught me that persons suffering from 
persistent pollutions will be benefited by sleeping 
with the head in a very low position, so that the 
brain can be better fed by blood. 

Again, the patient must not sleep longer than the 
necessary time, which should be determined for him. 
In bed he must not be covered too warmly, and he 
must not sleep on his back. His trousers must not 
be too tight. He must never sit on upholstered 
seats ; he must not ride on horseback ; he must avoid 
as much as possible conveyances; and he must not 
excite himself sexually without necessity. Of special 
importance is the regulating of sexual intercourse, 

1 La Semaine medical, 1900, No. 44. 



TREATMENT 311 

because the pollutions cannot possibly be cured dur- 
ing absolute abstinence. 

In the treatment proper the physician has to pay 
strict attention to the individual case. Hydro-ther- 
apeutic measures combined with a well-regulated 
manner of living, and eventually a trip to or a so- 
journ at a watering-place, will constitute a curative 
method most frequently leading to a satisfactory 
result. Balneotherapy 1 gives the best results in 
those cases of pollutions and spermatorrhea in which 
onanism and weakness of the nervous system are the 
causal factors. The use of pure chalybeate waters 
and ferruginous waters charged with carbonic acid is 
indicated in such cases. 

If the pollutions have originated from a state of 
hyperemia in the pelvic organs caused by some ab- 
dominal stasis or habitual constipation, good effect 
will be obtained by taking waters containing sodium 
sulphate, sodium chlorid, then the different bitter 
waters and some sulphur waters. We might add 
here that in a state of irritation in the sexual organs 
— i.e., in cases where chronic inflammation of the 
mucous membrane of the bladder or of the urethra is 
the cause of pollutions — the alkaline waters are to be 
recommended, and will do excellent service. When 
the mineral waters are taken internally we should 
observe certain precautions ; for example, only small 
doses must be ordered, so as not to surcharge the 
bladder, whereby an irritation would be induced. 
The waters must not be taken in the evening. An 

1 Kisch, Grundriss der klinischen Balneotherapie. Wien 
und Leipzig, 1883, p. 292. 



312 SEXUAL IMPOTENCE 

enema, however, before retiring, with the purpose 
in view of emptying the rectum and the lower bowel, 
and " thus relieving congestion of these parts and any- 
possible irritating effect the contents of the bowels 
may have" (Halsey), sometimes has an almost 
magic influence. 

When an increased morbid sensibility of the nerves 
is the cause of the pollutions we recommend the acra- 
tothermas of an elevated region; and the iron mud- 
baths are advisable for cases in which simple anemia 
is the cause of the disease. 

Various cold water treatments and sea-bathing are 
indicated in most conditions of weakness causing 
spermatorrhea, but these remedies should be selected 
cautiously, individual characteristics being taken into 
careful consideration. 

Rational gymnastics will always be of great value 
in subduing frequent pollutions. Schreiber 1 recom- 
mended for this purpose different exercises for cham- 
ber gymnastics which are very easy of execution, do 
not require any apparatus, and are of very good ser- 
vice, particularly so when supported by some* other 
means of treatment 

An electrical treatment is only rarely indicated. 
Recently, however, I have obtained very good re- 
sults from the use of the high-frequency sound. 

In the endoscopic examination some local treat- 
ment will often appear to be required or necessary, 
mostly the use of the sound or bojugie and some good 
method of cauterizing ; but always by the guidance of 

1 Aerztliche Zimmergymnastik. Leipzig, 1883, p. 95. 



TREATMENT 313 

the endoscope, of course. These measures lead most 
frequently to the desired result. Randall, 1 of Phila- 
delphia, reports very encouraging experiences on 
the endoscopic treatment of nocturnal pollutions. 

Bromids taken internally are sometimes of excel- 
lent effect in cases accompanied by erotic excitement, 
yet they are not infallible. Prescribing them is an 
easy matter, and the sight of a prescription is always 
some satisfaction for both doctor and patient ; only 
this satisfaction is not always of long duration with 
the patient. Camphor also may be used in some 
cases, but oftener in the shape of a suppository than 
otherwise. A trial with secale cornutum, with 
tinctura veratri viridis, monobromated camphor, an- 
tipyrin, sodium nitrate, and eventually with solutio 
Fowleri, may also be advisable. 

According to Rosenthal, 2 atropin has a good effect, 
but only in cases of prostatorrhea. I had a pre- 
judice against atropin, and until lately did not dare 
to make any use of it, although in certain cases I 
have felt tempted to make an experiment with it in 
consequence of Loewenfeld's 3 recommendation. 

Ott 4 claims that when atropin is given, irritation of 
the secretory nerves of the prostate is without effect. 
Nikolsky is of the same opinion, while Spina thinks 
differently, and Nagel 5 emphasizes that such an 

1 Transactions of the Section on Geni to- urinary Diseases of the 
Am. Med. Assoc, 1914, p. 48. 

2 Ueber den Einfluss von Nervenkrankheiten auf Zeugung und 
Sterilitat. Wiener Klinik, 1880, Heft 5, p. 160. 

3 Sexualleben und Nervenleiden. Wiesbaden, 1899, p. 232. 

4 Op. cit., p. 858. 

5 Op. cit., p. 84. 



314 SEXUAL IMPOTENCE 

action of atropin would be surprising when we know 
that this drug has no paralyzing effect upon other 
vasodilators. 

M. Meisels, under the direction of Professor A. 
Bokai, made some experiments with cornutinum 
citricum, and he asserts that doses of 0.003 to 
0.006 (gram) per day acted very favorably in para- 
lytic spermatorrhea. In most of the cases the 
sperm effusion diminished on the second or third 
day, or it ceased altogether. In from one to two 
weeks a cure generally resulted. This medicament 
had no disagreeable effects even after nine months' 
continuous use. In spastic forms, however, cor- 
nutinum citricum is considered to have no effect. 
I have tried this remedy in one case only, with ap- 
parently good effect. The price is exceedingly high. 

Professor Bozzolo and Mangianti recommend the 
following prescription for spermatorrhea and an- 
aphrodisia of neurasthenics: 1$. Cornutin. citr., 0.03; 
cretse praspar., 3.0; gummi tragac, 6.0. M. f. pil. 
No. xx. S. 2-4 pills daily. 

H. Feleki 1 reports good results from fluid extract 
of golden-seal given fifteen to twenty drops three 
times a day. 

Of course, diseases which induce pollutions must 
be treated and removed in any case whether pollu- 
tions appear or not. Such are ascarides, itching and 
smarting cutaneous eruptions about the genitalia and 
vicinity, also hemorrhoids and fissures, strictures and 
phimosis. Whenever chronic prostatitis or patho- 

1 Orvosi Hetilap, 1900, No. 50. 



TREATMENT 315 

logical changes on and about the verumontanum can 
be detected, everything must be done that is indi- 
cated in the treatment of the special condition. 
Thus very good results are obtained from massaging 
the prostate, deep urethral irrigations and properly 
performed local applications. 

The various mechanical devices invented for pre- 
venting pollutions cannot be of much use, since, 
though, if well constructed, they may prevent now 
and then a nightly effusion, they do not thereby con- 
tribute much toward the complete removal or cure of 
the disease, except in certain cases of neurasthenic 
conditions and states of habit. The arrangements 
that prevent the patient from lying on his back de- 
serve more consideration. 

In special cases I have followed Lallemand's 1 ex- 
ample and ordered continuous application of cold, 
whereby some rather satisfactory results were ob- 
tained. I used in these cases Chapman's tubes or 
pipes, which facilitate the application, which is not 
very convenient under any circumstances. 

Kisch 2 states that partial bathing is recommended 
against pollutions in youthful individuals. For the 
bathing of the occiput, the patient is in a horizontal 
position and has the back of his head in a specially 
shaped basin filled with cold water. Stimulating 
applications for the upper arms, by means of some 
towel-like material soaked in cold water, and with a 
dry cover, are likewise of good effect now and then. 

1 Lallemand, op. cit., tome ii, pp. 46-56. 

2 Op. cit., p. 293. 



316 SEXUAL IMPOTENCE 

Finally, I wish to mention for occasional application 
Winternitz's psychrophor, cold clysters, and Atz- 
perg's cooling probe for the rectum. 

Sometimes the cure may be assisted by the pa- 
tient's will and firm determination to awaken at the 
proper time. 1 For the cases where the pollutions 
take place in the mornings, we have L. Casper's 2 ad- 
vice to awaken the patient regularly by some ar- 
rangement an hour before the phenomenon usually 
occurs, so that he may urinate. This is certainly 
good advice, because in this way you may break the 
force of habit. The patient, however, must not be 
allowed to fall asleep again. 

Following a suggestion made by Albert Abrams 3 
I was able to obtain very good results by placing at 
bedtime under the foreskin a piece of cotton dipped 
into a 10 per cent, solution of cocain. 

In extreme and apparently incurable cases of real 
spermatorrhea, in cases where the patient is being 
greatly damaged in body and mind by the constant 
drain "most radical measures" are justified, and 
vasectomy, as advised by Lydston, 4 should be per- 
formed. Of course, the patient must be made to 
give his consent with the full understanding as to 
the consequent sterility. The operation itself is 
easy and harmless. 

1 Campbell Black, On the Functional Diseases of the Urinary 
and Reproductive Organs. London, 1875, p. 172. 

2 Dr. Leopold Casper, Impotentia et Sterilitas virilis. Miinchen, 
1890, p. 102. 

3 Diagnostic Therapeutics, Rebman Co., N. Y., 1910, p. 223. 

4 Op. cit., p. 623. 



TREATMENT 317 

Of late I have followed Belfield's recommenda- 
tion, 1 and in place of performing vasectomy, occlude 
the vas with a silk ligature. This procedure has, 
as Belfield emphasizes, the advantages that it 
surely occludes the vas, and that while the vas is 
occluded it does not obliterate, and its patency may 
be restored by removing the ligature. Under these 
conditions one does not have to hesitate so much 
as formerly before resorting to this therapeutic 
measure. 

I shall now return to the discussion of the different 
modes of treating impotence itself. In sexual weak- 
ness or anaphrodisia special weight is to be laid on 
a hygienic manner of living. Food, physical exercise, 
and rest, also dwelling and clothing, must be strictly 
directed according to the rules of hygiene. 

The diet is of special importance in the treatment 
of chronic diseases. Sexual impotence forms no ex- 
ception to this rule. There is no doubt that the 
mode of nourishing has a greater influence upon the 
virile strength than is usually admitted by modern 
authors. 

Roubaud has with more industry than discrimina- 
tion compiled a long list of so-called aphrodisiac arti- 
cles of food. Many of them exert in proper cases 
some influence; others are of no effect; but all are 
harmless, unless our olfactory sense takes exception 
at garlic. The other substances, for instance: Saf- 
fron, mustard, cinnamon, sage, carrots, turnips, mar- 

1 Some causes of sterility and impotence in the male. Jour. Amer. 
Med. Assoc, October 19, 1912, p. 1420. 



3l8 SEXUAL IMPOTENCE 

joram, nutmeg, cardamom, arrowroot, laurel, leek, 
ginger, onions, cloves, peppers, parsnips, celery, fen- 
nel, vanilla, oysters, fish, game, and pork, well pre- 
pared, can be eaten and tolerated by most people. 
They might act as mild stimulants, though we do not 
expect from them as much as Roubaud did. 

The proposition, however, is not as simple as it 
seems at the first glance, and we must strictly indi- 
vidualize, considering carefully the patient's condi- 
tion, and the form of sexual weakness we have to deal 
with. It is admitted that a man whose impotence is 
caused by diabetes must observe a diet where sugars 
and starches are reduced to a possible minimum. 
When we are consulted by a patient whose sexual 
incapacity is caused by obesity we would do positive 
evil if we were to prescribe Roubaud 's or any other 
stimulating food. In such cases it will be necessary 
to advise our patients to avoid alcoholics, sugar, oily 
fishes, fats, and spices, to restrict the ingestion of 
carbohydrates, and to use soups and other liquids 
only in small quantities. Always individualizing, 
we will have to devise proper bodily exercise for such 
a patient, and as there almost invariably exists consti- 
pation at the same time, we must look after a proper 
and regular evacuation. A rather generous use of 
phosphate of soda, carlsbad salts or some of the 
more palatable preparations like Kutnow's powder, 
will be found of great benefit in nearly all cases of 
sexual diseases whenever constipation is present. 

The best results are obtained from a generous, 
roborant, and eventually stimulating diet in cases 



TREATMENT 319 

where the sexual weakness is caused by a general de- 
bility of the body or by anemia; in cases of sexual 
neurasthenia where the muscles are undeveloped and 
flaccid; and in cases when impotence is caused by 
chronic alcoholic and other intoxications. But even 
in these cases we must individualize strictly and 
select the food carefully, as frequently the digestive 
organs refuse to do the work properly, and just as 
frequently a stimulating and accordingly exciting 
diet is able to influence unfavorably existing prema- 
ture ejaculation and morbid night-emissions. There- 
fore, we have very often to resort to a food that will 
not tax the digestive organs, but will stimulate with- 
out morbidly exciting. Raw eggs are frequently of 
great service, but even they, just as alcohol, spices, 
and a rich, especially a prominently nitrogenous diet 
are liable to act as two-edged knives do, and cause 
only harm to all those high-livers who endeavor to 
stimulate the activity of their auto-intoxicated 
organs by stuffing themselves with oysters, caviar, 
cheese, ale, porter, and many other exhilarating 
substances. 

In general, the nourishment must be suited to the 
state or condition of the body, every superfluous 
production of fat being injurious to virility. On the 
other hand, it is to be noticed also that individuals 
who are possessed of considerable sexual power enjoy 
a good appetite and digestive power, although they 
are not gourmands, or do not become such until their 
riper years. Persons with low sexual capacity are 
either gluttons or possessed of small digestive power. 



320 SEXUAL IMPOTENCE 

Every physician should inquire about the nourish- 
ing material of every impotent patient, and correct 
any existing error. Our purpose does not admit of 
the use of the diet for producing corpulency, as indi- 
cated by Mitchell, Playfair, and others. I am ready, 
however, to admit that considerable good may be ac- 
complished in some cases where such treatment is 
modified in the manner that Fiirbringer 1 proposes, 
— i.e., that the patients do not have to stay in bed, 
are allowed open air exercise and light mental work ; 
but then we do not follow Mitchell and Playfair. 
Furbringer is approaching my point of view, al- 
though he does not seem to notice it. 2 

Experience, which was gathered principally in 
North America, leads me to establish and to follow 
these main rules. The impotent must abstain from 
spirituous beverages. I make an exception only in 
the case of persons of feebly developed sexual desire ; 
these may take two glasses of German beer or one 
glass of good, strong California wine shortly before 
intercourse. I have already mentioned the favora- 
ble effect of beer in cases of precipitate ejaculation. 
Beer or wine, however, must never be taken in such 
quantities that the stimulating effect may be fol- 
lowed by a paralyzing influence, be it ever so slight. 

The manner of living must be strictly ordained in 
accordance with hygienic laws, and a proper propor- 
tion observed between physical or mental occupation 
and rest, which, however, is of equal necessity for the 

1 Die Storungen der Geschlechtsfunctioijen des Mannes. 
Wien, 1895, p. 66. 

2 Ibidem, p. 136. 



TREATMENT 32 1 

healthy and for the sexually weak. The patient 
ought to divert himself with mental exercise and 
amusements of every kind. Gymnastics, walks, sys- 
tematic breathing exercises and so forth should be 
resorted to in order to strengthen the body. Fatigue 
of every kind must be avoided, and every effort 
must be followed by an appropriate interval of rest. 

The principal rest is taken during sleep, and this 
must be apportioned to every individual according to 
his requirement. The patient in this respect is often 
in an unfavorable situation: if he sleeps sufficiently 
long to give his body the necessary repose, pollutions 
take place during the latter part of this time ; and if 
he denies himself part of this repose, then faintness 
and exhaustion appear and exert an unfavorable 
influence on the progress of the cure. We cannot fix 
upon the number of hours necessary for sleep in every 
case; but, on an average, eight hours should suffice. 
Of course, we must pay due attention to the condi- 
tion of dwelling and clothing. 

Although medicaments are not the means that in 
the treatment of impotence lead with great frequency 
and safety to a fortunate issue, yet they are what 
every sufferer desires and often asks for, after having 
given only superficial statements about his complaint. 
The question, "Will you prescribe something for 
me? " is never missed. The prescription may some- 
times, in connection with other remedies, have a 
good effect. Thus I shall now proceed to the discus- 
sion of the most common medicaments. 

Philters, or love-potions, have been known as far 
21 



322 SEXUAL IMPOTENCE 

back as the times of Moses. The mandrake that 
Rachel is reported to have eaten to become prolific is 
now supposed to be atropa mandragora, and belongs 
to the genus belladonna. Philters are brewed and 
drunk in our days, with and without effect. 

And now we come to the question of aphrodisiacs. 

Some idealists among physicians, and some of 
those who are completely wrapped up in interesting 
and rare cases, in brilliant surgical operations, seem 
to think that there is no necessity for an aphrodisiac, 
and that it is below their dignity to consider such a 
subject. Of course, the patients think differently, 
and the demand for a true and real aphrodisiac is 
great. 

Almost thirty years ago I asserted that medicines 
only seldom lead to good results in the treatment of 
sexual impotence, and I have had no reason to 
modify my opinion since. But whenever I meet a 
case of so-called psychic, neurasthenic or even 
paralytic impotence I always wish I had a good 
aphrodisiac to give. 

The deeper we penetrate into the study of the 
various forms of sexual inability, the larger our ex- 
perience grows, the fewer are the cases of psychic and 
neurasthenic impotence that we meet. Improved 
methods of examination enable us to bring many a 
case which formerly was looked upon as psychic im- 
potence, irritable weakness, etc., under the heading 
of a chronic affection of the prostate, the verumon- 
tanum, or some other plainly organic trouble. Some 
cases which formerly we were unable to explain and 



TREATMENT 323 

therefore simply called psychic, are now recognized 
to be due to autointoxication. Still there always 
remains a considerable number of patients in whom 
the whole trouble seems to be an untimely action of 
the inhibitory center, and in these cases a reliable 
aphrodisiac would be of great value. I am, therefore 
sorry to state, that the closer study of all the reme- 
dies which our ancestors were pleased to call aphro- 
disiacs, leads only to the conclusion that there is no 
such thing as an aphrodisiac. And the worst is that 
we must include in this negative judgment all the 
newer remedies, and even those about the brilliant 
effects of which we are reading a great deal. On the 
other hand, we have learned that anything which 
benefits a person's general system, also acts as an 
aphrodisiac. 

Cantharides and its preparations were in former 
times the commonest remedies used for impotence. 
If taken internally, the most effective substance of 
the cantharides, the cantharidin, is excreted by way 
of the urinary passages. On these passages cantha- 
ridin has a very irritating influence, and in propor- 
tion to the size of the dose it may lead to serious 
hyperemia of the mucous membranes of the urinary 
passages, to albuminuria, hematuria, and cystitis, 
and, in the worst cases, to croupy deposits on the 
mucous membrane of the bladder. As secondary 
symptoms we may have dysuria, stranguria, and 
painful erections. These erections are certainly to 
be called pathological, and yet they are to do service 
in coition. Doses of cantharides so small that they 



324 SEXUAL IMPOTENCE 

do not cause any perceptible inflammation of the 
urinary passages do not cause erection, and doses so 
large as to cause energetic erections are creative 
of such dangers that only the despair of a patient or 
the ignorance of a physician can give rise to a 
thought of applying them. The patient, sufficiently 
ignorant and sometimes in such a state of mind as to 
be willing to sacrifice his life for one night of pleasure, 
is excusable, but there is no excuse for a medical man 
who would use cantharides, because if they are an 
aphrodisiac then acute gonorrhea with an inflam- 
mation, causing mighty erections, is also one. It is 
really surprising that some authors still recommend 
its use. 1 Cantharides must never be brought into 
requisition in the treatment of impotence, neither 
the oil-beetles (May- worms), meloes majales, which 
are related to the cantharides by the acid of can- 
tharidin which they contain, nor the oil or tincture 
of ants, used in South America. 2 

Phosphorus was known to the ancients as a rem- 
edy for sexual weakness. It has a stimulating influ- 
ence on the nervous system. In regard to this rem- 
edy we have the observations by Alphonse Leroy and 
Bouttotz, 3 and those of Delpech, which show phos- 
phorus to be a powerful stimulant. I have fre- 
quently had occasion to use phosphorus for impotence, 
and feel justified in saying that in some cases it has 

1 Arthur Cooper, The sexual disabilities of man. Hoeber, New 
York, 191 1, p. 170. 

2 Rosenthal, op. cit. Wiener Klinik, 1880, Heft 5, p. 163. 

3 Roubaud, Traite de l'lmpuissance. Paris, 1876, p. 133. 



TREATMENT 325 

given satisfaction. I noticed particularly the favor- 
able effect it had on the mood of the patients, and 
feel convinced that it is of decidedly good effect in 
cases where the patient has become indifferent or 
melancholy. There is no bad effect noticeable in the 
cautious administration of phosphorus, even from 
continued use (in pills or capsules of o.ooi gram three 
or four times daily, or of phosphoric acid twenty to 
thirty drops in a glass of sweetened water several 
times a day) . 

Nux vomica and its preparations are of very great 
value in all forms of impotence, although the effect is 
not very vigorous, and, I am sorry to say, is of but 
short duration. 

The extract and the tinctura nucis vomicae, but 
mainly strychnin, are justly considered as tonics and 
remedies that excite the appetite and preserve their 
character as good nervines in many neurasthenic dis- 
eases. Hence it will be worth while to give them a 
trial; it will be accompanied with some advantage. 
I saw the best results with patients who were other- 
wise healthy, but felt a diminution in their sexual 
power without any assignable cause. It is true, the 
effect of nux vomica is not lasting, but after discon- 
tinuing it the sexual power will not sink below the 
level that existed before the use. The doses recom- 
mended are from five to twenty-five drops of the 
tincture, or o.oi (gram) of the extract, three times a 
day, and one to two milligrams of strychnin two or 
three times a day. Lately I obtained better results 
from hypodermic injections of strychnin, as recom- 



326 SEXUAL IMPOTENCE 

mended by Lydston. 1 I prefer, however, the strych- 
ninum nitricum to the sulphuricum, and resorted 
frequently to larger doses than advised by Lydston, 
going up to one-twelfth grain, the average dose being 
one-thirtieth. Wherever the hypodermic use of the 
drug is not practicable, almost identical results can 
be obtained by rectal suppositories. 

I have only seldom made use of brucin, because it 
is so very unreliable and of such different effect on 
different individuals. 

Casper 2 is of the opinion that air pin exerts a 
stimulating action on the genitals. He prescribes 
pills containing 1/250 to 1/120 grain atropin to be 
taken three to four times a day. Lately I have used 
atropin in combination with cathartics to good 
advantage. 

Secale cornutum and its preparations are also rec- 
ommended for impotence, or rather as aphrodisiacs ; 
but, as their effect is of but short duration, and, 
moreover, is quite unreliable, we can dispense with 
them in all cases unaccompanied by spermatorrhea. 

Ergotin was recommended by Maximilian v. Zeissel 
to be used in combination with quinin. I think that 
the quinin as a roborant in this combination is the 
more powerful ingredient in the prescription. 

Quinin, either alone or in combination with easily 
assimilable preparations of iron, will effect in anemic 
and weakly impotent persons all it is capable of 
effecting in anemia and weakness. If, therefore, a 

1 Op. cit., p. 590. 

2 Text-book of Genito-urinary Diseases, Phila., 1909, p. 615. 



TREATMENT 327 

physician has reason to assume that a patient 
requires a roborant, then he will with some ground 
appeal to quinin or iron; but he need not expect 
therefrom a specific effect on the sexual functions. 

Equally uncertain are the volatile stimulants, as 
musk and castoreum. They may induce libido but 
no erections, and are consequently dispensable. 

In the Orient especially some narcotics enjoy the 
renown of being aphrodisiacs. Indian-hemp, opium, 
and morphin given in certain doses produce undoubt- 
edly sexual excitement followed by powerful erec- 
tions. It is a known fact that hashish-eaters and 
opium-smokers experience heightened sexual impulse 
in the beginning of these fatal habits. Pal 1 dem- 
onstrated that opium and morphin have a stimu- 
lating action upon the nerves of the intestinal walls. 
The "just, subtle, and mighty opium" is capable of 
rousing the sexual desire to a very high degree, 2 and 
this is, no doubt, due to increased reflex irritability 
of the spinal cord. These means are, nevertheless, 
quite unsuited to our purpose, on account of their 
transitory effect as well as the subsequent relaxa- 
tion, and also on account of the danger that their use 
may lead to a habit, the fatal consequences of which 
are well known. At best the trial might be made to 
raise the confidence of a patient suffering from neu- 
rasthenic impotence; but this would be done at the 
risk of a perfect failure, since the effect of the opiates 
is so much dependent upon the individual. I am 
inclined to believe that these narcotics are no aph- 

1 Wiener Med. Presse, No. 45, 1900. 

8 Paul Bonnestain, L'Opium. Paris, 1887, p. 493. 



328 SEXUAL IMPOTENCE 

rodisiacs in the sense of heightening the sexual 
power even momentarily, but probably act favorably 
by dulling the inhibitive centers which so often 
interfere with the desired erections. 

Valerian has unjustly the name of an aphrodisiac, 
because it only lowers the reflex irritability of the 
spinal cord, and for that reason it is recommended as 
a sedative by Arndt. 1 

The mildly working stimulants, as vanilla, cinna- 
mon, galanga, and several spices, are of very transi- 
tory and unreliable action, and operate only in per- 
sons who are easily excited sexually. 

Cocain taken internally invariably produced sex- 
ual excitement in a man fifty-six years old. I had 
previously noticed a diuretic effect of cocain, but I 
am unable to decide whether there is any causal con- 
nection. Cheerfulness is always the effect of an in- 
ternal use of cocain. This is diametrically opposed 
to the observations of Dr. H. Wells, of the United 
States Navy, who asserts that he has noticed in co- 
cain an anaphrodisiac effect. Further experiments 
and investigations would certainly be interesting. 
The drug, however, is too dangerous to trifle with. 

The little lizard, scincus mar inns, anything but 
pleasing, has for a long time been praised as a popu- 
lar remedy, and in some countries is even now named 
as a domestic remedy, and yet it contains no sub- 
stance whatever that can act as an aphrodisiac. At 
best its fat might possibly induce salacity. 

Again I repeat that we must come to the conclu- 
sion that whatever our ancestors termed an aphro- 

1 Neurasthenie. Wien und Leipzig, 1885, p. 246. 



TREATMENT . 329 

disiac was no such thing, and that there is no wonder 
that industrious fellows have tried to supply the 
ever present demand. We couldn't even think of 
enumerating the endless legion of preparations 
thrown upon the market. Of some of them we are 
thoughtfully reminded at regular intervals by the 
most alluring pamphlets and testimonials. Most of 
these testimonials cry to heaven, testifying loudly to 
some doctor's credulity, ignorance or even venality. 

Damiana (Turnera aphrodisiaca) , its liquid ex- 
tracts, and other quite elegant American prepara- 
tions are not what they are represented to be by the 
extraordinary advertisements. 

Recently a new aphrodisiac has been heralded urbi 
et orbi under the name of Yohimbin. Professor A. 
Loewy, 1 of Berlin, says that this is the name given by 
Spiegel to an alkaloid extracted from the bark of an 
African tree called yumbehoa or yohimbehe, appar- 
ently belonging to the rubiaceas. To another alka- 
loid the name of yohimbenin has been given. A 
decoction of the bark of the tree is used by the Afri- 
can natives as an aphrodisiac. Loewy experimented 
on mice, cats, and dogs with hydrochlorate of yohim- 
bin, and noted a dilatation of the vessels supplying 
the genitalia, swelling of the testicles, and full erec- 
tion of the penis. The local results resembled very 
much those of cantharides, but without the irritant 
effect on the kidneys. Even repeated trials on one 
and the same animal produced apparently no inflam- 
matory changes in the parts. Overdoses caused in 

1 Beitrage zur Wirkung des Yohimbin. Berlin, klin. Woch- 
enschr., 1900, No. 42, p. 927. 



330 SEXUAL IMPOTENCE 

warm-blooded animals interrupted respiration, les- 
sening of the pulse rate, and fall of the blood-pressure. 
If artificial respiration was continued, the pulse rate 
and blood-pressure gradually diminished in a propor- 
tionate ratio until death occurred from cardiac par- 
alysis. When proper doses are given the action 
seems to be confined to the genitalia alone. One 
patient took 5 mgm. three times a day internally; 
genital hyperemia and powerful erections followed, 
but the libido was not increased. 

Professor E. Mendel, 1 of Berlin, after mentioning 
Oberwarth's physiological experiments on animals, 
reports that he used the yohimbin in 40 cases of im- 
potence, 5 to 10 drops five times a day and subcu- 
taneously, that he never saw untoward effects, and 
found the remedy to be sometimes of immediate and 
noticeable benefit in cases of irritable weakness and 
paralytic impotence. Many patients did not report 
results, and half the number of those who did were 
not influenced at all. Mendel admits that all appar- 
ent results may be due to suggestion, and recom- 
mends further experiments. 

Eulenburg 2 recommends the yohimbin for cases 
of neurasthenic impotence in place of any other 
medication, he is satisfied with the results and uses 
the drug in the form of subcutaneous injections of a 
2 per cent, solution, 0.5 to 1.0 per dose. 

The yohimbin hydrochlorate is to be used in a 1 
per cent, solution and the dose is 10 drops, equal to 
0.005 gram, three times a day ; the dose may safely be 

1 Therapie der Gegenwart, July, 1900. 

2 Deutsche med. Wochenschr. May 29, 1902, p. 402. 



TREATMENT 33 1 

increased to 15 drops, or 0.0075 gram. In order 
to preserve the solution it must be kept in a dark 
bottle, and one drop of chloroform added. 

Thus we have a preparation for which powerful 
aphrodisiac properties were and still are claimed 
from otherwise trustworthy and authoritative sides. 
Yohimbin advertised ethically, but extensively dur- 
ing more than ten years past, has received the en- 
dorsement of people whose word is almost law in the 
medical world. In spite of all that, it is decidedly 
but a new disappointment. In 1901 I reported on 
yohimbin and asserted that, as far as my personal 
clinical experience went, yohimbin is of no effect in 
healthy persons, and showed no effect with any of 
my impotent patients. At the same time I said the 
following: "The only apparent result was obtained 
in the case of a fifty-year-old neurasthenic, who was 
ordered to take one 0.005 gram yohimbin tablet 
every evening. The second night he woke with an 
erection, which had not occurred for several months." 

Such a modest result in one of several cases cer- 
tainly could prove nothing, and was, as later experi- 
ments proved, quite accidental. But even this little 
accident was seized upon as a welcome pretext by the 
clever advertisers of yohimbin to place my name upon 
the list of the credulous admirers of this drug, and 
mention me with a number of authors, "some of 
whom are enthusiastic over" yohimbin's "results in 
neurasthenic impotence." 

In order not to be misunderstood in the future, 
even by the most interested parties, I am now ready 
to declare that in my opinion yohimbin has no value 



33 2 SEXUAL IMPOTENCE 

as an aphrodisiac. I have given it a fair trial, in 
fact, more of a trial than the remedy deserved, and 
certainly more than was good for the purse of many 
a help-seeker. Without doing an injustice I can 
even go further, and directly warn against its use. 
My reasons for such a warning are two : First, at its 
best yohimbin is useless. I have never seen the 
slightest benefit in any of the numerous cases in which 
I tried it. Second, in a few instances it has directly 
done harm. Persons afflicted with any kind of a dis- 
turbance of the circulation do not tolerate yohimbin. 
I shall briefly report the history of one typical case. 
A showman, 52 years old, drinker, slightly arterio- 
sclerotic, but boasting of excellent health, consulted 
me in an off-hand way, complaining of gradual failing 
of his sexual power. While there was desire and 
love for a handsome wife, the necessary firmness of 
the erections was lacking. The man was certainly 
a better subject for an experiment with yohimbin 
than Loewy's celebrated castrated dogs, on whom 
yohimbin promptly provoked erections. I prescribed 
the 5 milligram tablets of yohimbin, as the patient 
did not consent to an examination, thinking that 
was not necessary, he wishing simply to be given 
something that would cause erections. One single 
dose taken at bedtime brought no erections, but a 
condition which the wife described as collapse. I 
saw the patient two hours later when he, as I was 
told, had partly recovered. He still complained of 
dizziness, weakness and nausea; the pulse irregular, 
flighty, the skin perspiring freely. Supposing that 
it was a case of idiosyncrasy, I advised that no more 



TREATMENT SS3 

yohimbin be taken. A few days afterwards, the man 
hankering for the prospective erections, took another 
tablet. This was followed by similar symptoms as 
the first dose, with the difference that this time the 
patient was not frightened and did not alarm his 
better half, whose peaceful sleep he disturbed in no 
way. There being not even a semblance of an erec- 
tion, he never felt tempted to take another yohimbin 
tablet. 

Slight disturbances in the form of dizziness, nausea 
and general ill-feeling I have observed in several 
cases, and am convinced that Krawkoff 's conclusions, 
to which he came after a series of carefully conducted 
experiments on animals and men, are correct. 
Krawkoff claims that yohimbin paralyzes the motor 
ganglia of the heart, and that any congestion of the 
sexual organs is due to its vasodilating effect. 

But however that may be, and even admitting that 
the drug in small doses is non-toxic, my personal 
clinical experience with yohimbin, and the verbal 
information collected from various fellow-practition- 
ers are for me reason enough to abandon this medi- 
cine for good. 

One thing, about yohimbin, however, I fail to 
understand. How was it possible to arouse the 
enthusiasm of some prominent members of the pro- 
fession? How did they obtain the brilliant results 
with patients suffering from paralytic impotence, 
nay! even on castrated dogs? Was their yohimbin 
different from the one we obtain ? I must doubt this 
when I consider that my results were uniformly 
negative, no matter where the drug came from ; they 



334 SEXUAL IMPOTENCE 

were not any better when, on various patients, I 
used the large quantities kindly sent to me for ex- 
perimental purposes. 

When experimenting on dogs I would advise to be 
exceedingly skeptical. It is almost laughable to 
notice the triumphant feeling, when some of the ex- 
perimenters found that yohimbin injections were 
followed by "reddening and swelling of the penis," 
that the member was rather stiff, stretched out and 
greatly strained. A controlling handling of a dog's 
genital organs without any kind of a previous in- 
jection, would have shown how sensitive to the slight- 
est touch they are. 

I believe further, that Eulenburg, after injecting 
subcutaneously one or two centigrams of yohimbin 
found that the erecting effect ensued quite slowly, 
usually in the morning following the injection given 
the previous afternoon or evening. Morning erec- 
tions are an easily obtained result with any kind of 
treatment, and cannot always be considered of value. 

Further, I should like to ask the question : Why are 
the effects caused by yohimbin, according to some 
enthusiastic experimenters, immediate, while we are 
variously informed that in man we may expect 
results only after using the drug from four to six 
weeks? Is it that Loewy's mice, cats and dogs are 
easier to influence, or because our man-patients must 
pay a good price for the remedy, and must be kept 
taking it for quite a while ? 

Loewy, the chief yohimbin enthusiast, goes so far 
as to compare this drug's action to that of cantharides 
and there he may be right ; cantharides also have no 



TREATMENT 335 

aphrodisiac action in non-toxic doses; and as we do 
not intend to use either one in toxic doses we are 
fairly justified to leave both of them alone. 

Yohimbin made its entrance into the realm of 
medicine recommended by great authorities, and we 
must be skeptical when other new remedies are hailed 
by the same or even other shining stars of the medi- 
cal world. It was, therefore, with distrust only that 
I approached muiracitkin, the newest of the "harm- 
less, effective and lasting" aphrodisiacs. Its main 
constituents are said to be muira puama, a " power- 
ful aphrodisiac," and as such, " recognized by the 
natives of Brazil," and lecithin which was always 
recognized by its manufacturers as "invaluable in 
cases of debility" and to be "a restorer of appetite," 
a "weight increaser" and at the same time "non- 
toxic and perfectly assimilable." 

While I was never able to obtain any results with 
the various lecithin preparations I decided to try 
muiracithin. It came so well recommended : Leyden 
and Bramann liked it, it was being employed by 
Senator, Mendel and others. Mendel, of course, was 
fairly enthusiastic about yohimbin, and I became 
doubly skeptical. Fiirbringer, for whom I have al- 
ways had the greatest admiration, published an 
article in which he mentioned muiracithin and rec- 
ommended it, in a guarded manner, however, for trial. 

The drug, as to be expected, is expensive. A 
druggist ordered a large supply, and I began to use 
it in several cases, including a sexually normal in- 
dividual. 

To be just, it must be acknowledged, the patients 



336 SEXUAL IMPOTENCE 

were none the worse for using muiracithin, but none 
of them noticed the slightest effect upon their sexual 
power and feelings. 

I wrote to Furbringer, giving him my experience 
with yohimbin and muiracithin. He was kind 
enough to answer my letter, saying that he was glad 
to see that we are of the same opinion in regard to 
these two remedies. 

While I am fairly sure that there is no real aphro- 
disiac in existence, I have not given up the search 
for it. For quite a while I was experimenting with 
the fluidextract of the cortex of muira puama, the 
Brazilian Acanthacea, and with the fluidextract of 
Catuba, another Brazilian "aphrodisiac" produced 
from Juniperus brasiliensis, but am unable to report 
anything favorable. 

For the sake of completeness, and also as a curios- 
ity, I must state that homeopathy also has taken 
an interest in sexual weakness, and endeavors to treat 
it by administering the salts of copper, gold, iron, 
lead, etc. 1 

The various hydro-therapeutic processes have 
always enjoyed a special fame, and are highly recom- 
mended by men in and out of the medical profession 
for the states of sexual weakness. The reputation of 
hydrotherapy in general increases every day, and 
with it also that of its special application in the treat- 
ment of impotence. Every one who feels a begin- 
ning of impotence resorts, with or without medical 

1 Dr. Christof Hartung von Hartungen, Ueber virile 
Schwache und deren Heilbarkeit auf inductivem Wege. Wien, 



TREATMENT 337 

advice, to cold water ablutions and sitz-baths. These 
remedies are of feeble action and produce but little 
effect. 

In order to understand the action of water on parts 
of the human body which are in a pathological condi- 
tion, we have to call to mind the principles of hydro- 
therapy. The stimulating effect of water upon the 
body is always twofold — thermal and mechanical, 
the one or the other prevailing according to the man- 
ner of application. 

The impress of the thermal stimulus 1 upon the 
peripheral terminations of sensitive cutaneous nerves 
is transmitted to the central organs, appreciated by 
these as sensations of warmth or cold, and trans- 
mitted by them by reflex action to the motor system. 
It is probable that thermal effects have also a local 
action through the influence of peripheral ganglia or 
the excitable tissue itself, and without the mediation 
of the central nervous system. Again, 2 the applica- 
tion of a lower temperature over large vascular trunks 
causes the latter to contract. This narrowing of the 
main vessels induces diminution in the afflux of 
blood toward the peripheral ramifications of the 
trunk- vessels that are contracted, whereby is also in- 
duced a lowering of the temperature in the parts of 
the body supplied by these blood-vessels. Again, ex- 
periments 3 have proven that by the local applica- 
tion of water of different temperatures we can alter 
at will the local warmth of a part of the body even to 

1 Winternitz, Hydrotherapie. Wien, 1877, Band i, p. 49. 

2 Winternitz, op. cit., Band i, p. 75. 

3 Ibidem, p. 36. 

22 



338 SEXUAL IMPOTENCE 

the deeper tissues. Finally, stimulation by cold in- 
creases considerably the tension and tonicity of the 
smooth and striated muscle acted upon as directly as 
possible. 1 

The action of the various procedures in hydro- 
therapeutics is therefore directed first on the nerves, 
by means of these on the vessels, and ultimately on 
smooth muscles. The water must therefore be ap- 
plied in accordance with the various requirements of 
the cases under treatment. 

There is no case of impotence where one or the 
other hydro-therapeutic process would not consider- 
ably assist any course of treatment ; and in many a 
case no other remedy is required to effect a cure. 
Again, it must be remarked that an untimely appli- 
cation of a hydropathic stimulus may also do harm. 

Out of the immense treasury of hydro-therapeutic 
procedures we can appropriate for our purposes local 
and general ablutions, rubbing down, flapping, 2 
sponge-baths, rain- or douche- or shower-baths, sitz- 
baths, half-baths, full-baths, vapor-baths, river- 
baths, sea-baths, and many mineral baths; also the 
application of cooling sounds and injections of cold 
water into the urethra and rectum. 

1 Winternitz, op. cit., p. 119. 

2 I would designate by the name of "flapping" a very im- 
portant and efficacious hydropathic procedure, which is exe- 
cuted in the following way: a coarse sheet, wet and cold, is 
wrapped around the body of the patient, the attendant slap- 
ping more or less gently, but always rapidly, the whole body 
up and down repeatedly until the skin is quite reddened and 
warm. A cold cloth is placed on the patient's head to avoid 
possible congestion. Flapping is usually followed by a cold 
half-bath. 



TREATMENT 339 

The action of simple ablutions is too feeble to be of 
much good in any form of impotence. They should, 
however, be observed as a hygienic rule for cleanli- 
ness, both by the virile and the impotent. Ablu- 
tions of the spine and loins act, nevertheless, as a 
gentle stimulus. Washing of the spine and genitalia 
with spirituous fluids is common as a domestic rem- 
edy. Roubaud recommends washing with tinctura 
nucis vomicae. As a matter of fact, I have seen 
really good results from the external use of tinctura 
nucis vomicae in several cases of purely neurasthenic 
impotence. 

Rubbing down and flapping are of excellent service, ' 
as they gently stimulate the nerves and assist in the 
assimilation of material; they thus are indicated in 
several forms of impotence. 

Sponge-baths may be substituted for shower-baths. 
They do not operate quite as powerfully, I admit, but 
they are more easily procured, as a round vessel not 
overlarge — a sitz-bath tub, for instance — or a porta- 
ble rubber tub and a good sponge are all that are 
requisite. 

Rain- and douche-baths are in many cases absolutely 
indispensable. Applied generally, the shower-bath 
assists powerfully in the assimilation of material. 
Applied locally, on the genitalia and spine, they ope- 
rate as a gentle stimulant, acting directly on the 
nerves and spinal cord. In certain conditions the 
douche filiforme, 1 or thread-like shower-bath, di- 
rected upon the glans is of good effect. 

In commonest use, however, are sitz-baths. Win- 

1 Winternitz, op. cit., Band i, p. 35. 



340 SEXUAL IMPOTENCE 

ternitz is of the opinion that the sitz-bath operates by 
means of a reflex stimulation of the nervus splanch- 
nicus. 1 He has made experiments 2 with these 
baths and obtained the following results: A short 
sitz-bath, of ten minutes and io° C, causes a lower- 
ing of the local temperature, which, however, is fol- 
lowed by increased warmth within half an hour, the 
reaction which ensues during the second half-hour 
being followed by a moderate decrease in the tem- 
perature for several hours. A sitz-bath of thirty 
minutes and of the same temperature causes a dimi- 
nution of the temperature during a longer time and 
to a lower degree. The reaction sets in later, seems 
less intense, and is followed by a marked compensa- 
tory lowering of the temperature. Very long con- 
tinued and very cold baths might postpone the reac- 
tion still more, and possibly prevent it altogether. 
Either short or prolonged sitz- baths of a temperature 
approaching that of the blood warm the rectum 
directly. The most important therapeutic results 
are obtained by hip-baths of 20 C. They usually 
cause no subsequent warming of the rectum, but con- 
stantly show a lowering of the temperature in the 
rectum. 

Hence short, cold sitz-baths must be considered as 
an exciting, stimulating form of bathing, while cold 
sitz-baths of longer duration induce depression and 
retard the process of local nutrition and heighten the 
vascular tonicity in the pelvic organs. Warm and 
hot sitz-baths have a relaxing effect. Temperate 

1 Winternitz, op. cit., p. 224. 

2 Ibidem, Band ii, p. 139, etc. 



TREATMENT 341 

sitz-baths, i8° to 25 C, are antiphlogistic. The 
cold sitz-bath is of main utility, and should be of a 
shorter or longer time according as a stimulating or 
sedative effect is intended. 

Of similar but more powerful effect are the so- 
called half-baths, which, along with the ordinary cold 
baths, must be considered as exciting, if they are not 
of too long duration, which is not likely to be the 
case, because a chill would compel its interruption. 
Very excellent results for the purpose of curing 
several forms of impotence in which stimulation 
is indicated are obtained by half- baths of 12 to 
1 8° C, combined with friction and showers during 
bathing. 

Even vapor-baths may be indicated in many cases 
of impotence; these have also a stimulating action, 
and, moreover, prevent the formation of adipose 
tissue. 

The most stimulating form of bathing is river- 
bathing and sea-bathing, which often perform real 
miracles with the impotent. Milder forms of impo- 
tence are very frequently cured by river-bathing 
alone, and still better by sea-bathing. In these baths 
there is, besides the thermal stimulus, an exceed- 
ingly strong mechanical excitation by the action of 
the flowing water and of the dashing of the waves. 
For river-bathing are to be preferred those rivers or 
parts of rivers which present a moderate depth com- 
bined with a strong and rapid current, and, likewise, 
for sea-bathing, places where the billowing is strong. 
Very great care must be taken in prescribing these 
forms of bathing, because patients who are run down 



34 2 SEXUAL IMPOTENCE 

and many neurasthenics cannot endure them very- 
well. Bathing in lakes is frequently indicated. It 
may be a thermal stimulus, and the movements 
made in the bath contribute to the acceleration of 
the elaboration of matter. Protracted bathing in 
warm water is scarcely ever desirable. 

The balneological treatment is merely in its incep- 
tive stage; but we know that soda and sulphurous 
waters do- very good service in nearly every form of 
impotence. The sulphur waters were recommended 
by French authors as early as Lallemand's time. I 
have occasionally noticed a favorable influence on the 
sexual life of patients who used sulphurous thermae 
for other causes. I have frequently ordered with 
best results bathing in natural salt-water, and also in 
artificial mineral salt or rock-salt water. 

Bathing in other mineral waters is advisable for 
those forms of impotence in which some specific 
mineral water treatment will remove causes of impo- 
tence, as, for instance, prostration, anemia, torpid 
digestion, etc. 

Excellent results are obtained from the so-called 
champagne baths at Vichy in California. Un- 
fortunately the stupidity of calling this marvelous 
place Vichy was committed ; the accommodations are 
poor and the waters therefore not duly appreciated. 

The Winternitz cooling-sound, psychrophor, is an 
unfenestrated catheter k double courant. Its appli- 
cation is adaptable in the treatment of all the forms 
of impotence connected with hyperesthesia of the 
urethra, especially of the colliculus seminalis. The 
instrument is introduced as far as the neck of the 



TREATMENT 343 

bladder, and preferably into the bladder. A con- 
tinuous stream of cold water flows through it, so that 
to the mechanical stimulus of the sound is added the 
effect of the cold. The psychrophor is borne even by 
patients in whom the sound cannot be introduced at 
all, or not often enough, on account of the violent 
pain produced. 

Simple injections of cold water into the urethra are 
very efficacious on account of the mechanical stimu- 
lation and the effect of the cold combined. The 
effect of such injections is merely exciting, while the 
psychrophor may, according to the duration of the 
application, have a depressing, even an antiphlo- 
gistic, action. The injection of cold water into the 
urethra is made use of, as I have noticed, by sailors 
as a means of temporary excitation after long con- 
tinence, and I wonder that we never read of this 
practice in medical literature. 

In order to act upon the prostatic part of the ure- 
thra we may in some cases make use of Azperger's 
rectal cooling sound 1 or of Winternitz's rectal cooling 
pouch. 2 The action is similar to that of the psychro- 
phor, while cold-water injections into the rectum act 
as do those made into the urethra. 

Application of dry warmth or cold has a similar ac- 
tion to that of hydro-therapeutic stimulation. Very 
considerable stimulation can be obtained, particu- 
larly if high and low temperatures are applied al- 
ternately. Roubaud 3 recommends a syringe for the 

1 Winternitz, op. cit., Band ii, p. 129. 

2 Ibidem, p. 131. 

3 Traite de l'impuissance. Paris, 1876, p. 146. 



344 SEXUAL IMPOTENCE 

application of hot air. Recently there have been de- 
vised several instruments, called thermo-psychro- 
phors, for alternate cold and hot water. 

Many newspapers have advertised the carbon- 
douche. In the application of this remedy the geni- 
talia are, by means of a peculiarly constructed appa- 
ratus, exposed to the direct action of carbonic acid 
gas. This action, though mildly stimulating, I con- 
sider has more of a psychical effect or influence. The 
external application of carbonic acid gas has already 
been recommended by Bernatzik, 1 and more recent- 
ly by B. Schuster in Nauheim. 2 The latter found it 
highly effective in cases of neurasthenic lessening of 
libido and erectility and in premature senile impo- 
tence. I saw very little effect in the few cases in 
which I have made use of it. Carbonic acid may 
have a better effect in female diseases. Carbonic- 
acid baths are of greater value. S. Rose, 3 of New 
York, said: "Carbonic-acid gas baths effect relief 
in many cases of impotency. Physicians at water- 
ing places are aware that in many the libido be- 
comes markedly stronger under treatment by car- 
bonic-acid baths." He recommends it as "an ex- 
cellent remedy" in neurasthenia sexualis. 

The different kinds of electrical currents are 
made use of in the treatment of impotence quite as 
often as the various procedures of hydro-therapeu- 
tics. Every kind of current has its advocate among 

1 Aphrodisiaca, Eulenburg's Real-Encyclopadie. Wien und 
Leipzig, 1885, Band i, p. 614. 

2 XVII. Versammlung der balneol. Gessellch. in Berlin, 
1896. 

3 New York Medical Journal, Jan. 13, 1900. 



TREATMENT 345 

the different authors, and every one extols the 
method he uses. This fact alone is enough to prove 
that science has not yet reached its zenith in refer- 
ence to the application of electrical currents. 

Erb 1 stated in plain words that nothing is known 
about the electrophysiological action upon the tes- 
ticles and vasa deferentia of the living man, and that 
the knowledge of the effect on the spinal cord is also 
very scanty. We must rely entirely on empiricism, 
or practical experience, and this teaches us that elec- 
tricity, in whatever way it may be applied, is of ex- 
cellent service in special forms of impotence, but that 
there are many cases where it is of no use, or may 
even do harm. A careful distinction of the sundry 
cases and a thorough investigation as to which are 
proper for electrical treatment is more necessary 
than in any other mode of treatment. Only a thor- 
oughly correct application can sufficiently reward 
our efforts by good results, and it is of the utmost 
importance to know what kind of current is to be 
chosen, of what strength it should be, and in what 
way applied. This necessitates a careful study of 
each individual case, with all its accompanying de- 
tails or circumstances. 

The galvanic current will be indicated frequently. 
We commence by localizing the electricity, apply- 
ing the zinc pole over the cord in the lumbar region, 
and the copper pole to the upper and under sur- 
faces of the penis, to the testicles, perineum, and 
the spermatic cord downward from the- inguinal 

1 Elektrotherapie. Ziemssen's Handbuch der allgemeinen Thera- 
pie, Band iii, p. 128. 



34^ SEXUAL IMPOTENCE 

ring. In other cases, when the spinal cord is to be 
operated upon, the copper pole is applied to the 
nucha, and the zinc pole to the region of the lumbar 
vertebras. A more powerful action is obtained if the 
copper pole is applied to the lumbar region and the 
zinc pole to the perineum or to the pars prostatica by 
means of the bladder rheophore. A still stronger 
effect is produced by the introduction of the copper 
pole into the rectum by means of the rectal rheo- 
phore, and the zinc pole as far as the pars prostatica. 
Only weak currents, however, can be applied, and but 
once a week, as a more frequent application might 
induce inflammation of the mucous membrane. 

In the use of the bladder rheophore Lewandowski 1 
recommended the gradually increasing faradic cur- 
rent or very short interruptions in the application 
of the current. Besides, both poles may be applied 
externally along the course of the spermatic cords, 
when interruptions and reversing of the current are 
particularly effective. It must always be borne in 
mind, however, that an energetic electrical treat- 
ment can be of service only to individuals of very 
low electrical irritability. 

The time of application will have to be longer or 
shorter as the different cases may require. If the pa- 
tient is not affected with excessive anesthesia, 
or if the electrical irritability begins to return during 
the treatment, erections may occur even during the 
application, and this would very much raise the 
courage and confidence of the patient. 

1 Elektrodiagnostik und Electrotherapie. Wien und Leipzig, 
1887, p. 410. 



TREATMENT 347 

The manner of application of the faradic current is 
the same as that of the galvanic; but the induced 
current is not so frequently used for electrizing the 
spinal cord itself. By means of the metallic brush 
the glans and the testicles are directly excited rather 
strongly. Such an application produces a reddening 
of the skin, and serves therefore as a stimulant to the 
circulation of the blood in the parts in question to a 
higher degree than any other method of applying 
electricity. 

If one pole is introduced into the rectum to the 
height of the vesiculae seminales, while the metallic 
brush faradizes the testicles and the entire surface of 
the penis, an erection may very often be produced 
during the treatment, as Onimus 1 remarks, and this 
fact has also been observed by myself. 

Especially to be recommended is the application of 
weak induction currents during a longer time, be- 
cause they are apt to revive the excitability of weak- 
ened nerves, as has been demonstrated by von 
Bezold and Engelmann. 

Static electricity, franklinization, 2 or general elec- 
trization, and high frequency currents are frequently 
used and very good results have been obtained 
thereby in recent times. Eulenburg 3 asserts that 
carefully watched hydro-electric baths, electro-static 
air-baths, etc., are preferable to the process of general 
faradization and galvanization as indicated by Rock- 

1 Guide pratique d'Electrotherapie. Paris, 1882, p. 264. 

2 Stein, Die allgemeine Elektrisation des menschl. Kdrpers. 
Halle, 1883. 

3 Sexuelle Neuropathie. Leipzig, 1895, p. 40. 



348 SEXUAL IMPOTENCE 

well and Beard, because the latter are too compli- 
cated, cause loss of time, and are somewhat imperfect 
in their effect. 

Hydro-electric baths 1 and general franklinization 
with the influence machine will be positively indi- 
cated in impotence dependent upon constitutional 
diseases, disturbances in the general nutrition, or 
states of weakness, but most of all in those forms 
brought about by general neurasthenia. The effects 
of static electricity will, however, largely be due to a 
suggestive influence. 

In recent years I have frequently made use of 
high-frequency currents and of the high-frequency 
urethral sound; and while I am not so enthusiastic 
about this mode of treatment as Noble M. Eber- 
hart 2 is, I can report that the results obtained were 
most remarkable in many cases. 

Local treatment is most frequently indicated. 

In the first place comes local cauterization. Mod- 
ern physicians have simply returned to Lallemand's 
method of treatment, which has been so much 
criticised. The principle has remained the same, 
the mode of application only having somewhat 
changed. 

Lallemand cauterized the caput gallinaginis with 
a lapis-style or caustic-holder that formed part of a 
specially constructed instrument. To handle suc- 
cessfully Lallemand's instrument requires a certain 

1 Eulenburg, Die hydroelektrischen Bader. Wien und Leipzig, 
1883, p. 76. 

2 A Working Manual of High-frequency Currents, Chicago, New 
Medicine Publishing Co. 



TREATMENT 349 

dexterity which can be acquired only by practice; 
but when this dexterity is once acquired, the extent 
of the cauterization can be limited at will. Any one 
who became skilled in Lallemand's method of 
cauterization preferred it to all other methods until 
the endoscope was invented. 

Every one will soon convince himself that such 
brilliant and prompt results as we read of in Lalle- 
mand's wonderful work cannot be obtained in our 
days by any method of cauterization that may be 
adopted. The method has remained the same, man 
is the same, and the nature of the disease is still the 
same as in Lallemand's time. The difference be- 
tween our results and those of Lallemand can be ex- 
plained by the fact that we are not the inventors of 
this method of treatment, and are therefore able to 
look upon our results with greater impartiality. It 
will enter no one's mind to accuse Lallemand of hav- 
ing intentionally distorted the facts; but every one 
can easily understand that Lallemand, who had cor- 
rect ideas of the conditions in the urethra long before 
the endoscope came into existence, would see only 
the successful results of his method, and give little or 
no attention to his failures; also, that he overesti- 
mated the value of his invention. His brilliant suc- 
cess can be understood when we consider that in his 
time Lallemand was the only physician of renown 
who did not think it below his dignity to occupy 
himself with the different forms of sexual weak- 
ness; so that, as a natural consequence, people of the 
wealthy class suffering or imagining themselves to 
suffer from sexual weakness would flock to him from 



350 SEXUAL IMPOTENCE 

far and near. Comparing the number of psychically 
impotent with those that are affected with real impo- 
tence, we shall find that the former constitute a 
large portion of those applying for relief. Now with 
these neurasthenics Lallemand's fame, combined 
with the great renown of his method, must have ex- 
ercised a curative influence. Finally, we must not 
forget that great minds are not without a weakness 
or a hobby. I have a vivid recollection of a worthy 
clinician who died, unfortunately, too early. This 
gentleman thought he had discovered at one time a 
great epidemic of cerebro-spinal meningitis, and he 
became quite angry when his assistant merely 
sought for another explanation of the symptoms. 
When he had to treat obstinate patients who posi- 
tively refused to show cutaneous hyperesthesia, he 
would pinch their skin, so as to produce for his own 
satisfaction utterances of pain which would indicate 
to him the existence of hyperesthesia. 

Many German physicians took umbrage at the fact 
that they could not obtain the same brilliant results 
as Lallemand, and rejected his method altogether. 
In the eyes of other investigators Lallemand had pre- 
sumed too much through his mania for writing. Al- 
though Lallemand has really treated the whole ques- 
tion too broadly, every one will prefer his prolixity to 
the scant treatment given to the subject by many 
authors of the present time. Of course, we no 
longer accept many of Lallemand's views; as, for in- 
stance, his idea of the effect on the sexual power of 
riding, of tobacco, coffee, and tea. This, however, 
does not alter the fact that cauterizing after Lalle- 



TREATMENT 35 1 

mand's method does good service in pollutions, sper- 
matorrhea, or impotence caused by changes in cer- 
tain portions of the urethra. The endoscope enables 
us now to obtain positive knowledge about this cause. 

Swinburn's, Goldschmidt's, Wossidlo's, Buerger's, 
MacGowan's, and McCarthy's urethroscopes are 
most valuable additions to our armamentarium. 
They enable us to inspect the deep urethra, the 
colliculus seminalis and the trigonum, and see struc- 
tures in vivo which we were, until a few years ago, 
able to see only in anatomical dissections and prep- 
arations. 

Special care must be taken in cauterizing, and it 
should be undertaken only by medical men who are 
perfectly familiar with the handling of the endo- 
scope, and by them only under the control of this 
instrument. 

Lallemand did the best that could be done with 
the knowledge and means at his hands ; now it would 
be surely criminal to poke blindly into the compli- 
cated structures of the male urethra, and for a phy- 
sician to cauterize the deep urethra without seeing 
exactly what is being done would be as if one were 
arresting the bleeding of an amputation wound with 
the actual cautery. We hope, at least, that now when 
theingeniousness of Goldschmidt, Wossidlo, Buerger, 
Oudin, D'Arsonval and others have placed into our 
hands the endo-urethral knife and various endo- 
urethral electrodes, no real physician should be fool- 
ish enough to use antiquated appliances to slash and 
burn his fellowman's urethra. 

Some ultra-modern urologists, however, go a little 



352 SEXUAL IMPOTENCE 

too far in depending upon the urethroscope alto- 
gether. They poke it into the urethra of every 
patient falling into their hands, they find a red, 
swollen and inflamed verumontanum and then 
cut and burn without mercy, without even consider- 
ing that the local condition may be a symptom of a 
deeper trouble, or even may be caused. by their own 
manipulation. 

Cauterizing is now much facilitated, the need 
of a caustic-holder being dispensed with, since a 
lapis-style fastened on a piece of silver wire answers 
the purpose perfectly. The majority of physicians 
had for the endoscope a certain objection, which, 
as Grunfeld said, could exist only on the ground of 
their ignorance in regard to the details. This one 
application of the instrument should suffice to make 
its utility obvious to every thinking man. 

Immediately before the operation of cauterizing, 
the bladder should be completely emptied. One rea- 
son is to spare the patient the intense pain that 
would be induced by urinating soon after the opera- 
tion, and another to prevent the risk of having the 
effect of cauterizing very much interfered with by an 
involuntary discharge of urine while the operation is 
going on. Nowadays it hardly seems necessary to 
mention any reasons, as no competent physician will 
introduce any kind of an instrument into the urethra 
without first having the bladder emptied and disin- 
fecting the urethra itself. 

The eye of the operator will guide him as to the ex- 
tent of the cauterization, which, of course, will be de- 
termined by the pathological changes he observes, 



TREATMENT 353 

but in any case the cauterization must be confined 
within reasonable limits. 

Altogether I think cauterizing should be resorted 
to in exceptional cases only. The immediate effect 
is mostly satisfactory to the inexperiened urologist, 
who may even feel justified to rush into print to give 
to the profession the benefit of his experience in one 
lonely case. The local hyperemia, irritation and 
even inflammation caused by the searing generally 
give rise to erections, the patient is also elated, at 
least for a while. Unfortunately the erections 
mostly disappear with the subsiding of the local in- 
juries, and the patient is at least, in no better con- 
dition than before. In some cases a demonstration 
ad oculos, that erections are possible may be useful 
toward restoring the patient's confidence. But, and 
again but, this certainly could be accomplished at a 
smaller risk. 

A similar although more feeble effect may be ob- 
tained by the use of astringent injections. I have al- 
ready had occasion to state that injections of cold 
water exert a certain stimulating influence, being 
frequently followed by erections. Astringents cause 
a stronger irritation, and the stimulation is in direct 
proportion to the strength of the injection. 

Astringents for local excitation may be used also in 
the form of gelatin bougies. Dittel has had con- 
structed a special porte-remede, by means of which 
he applies to the pars prostatica astringents in the 
form of small urethral suppositories. 

Ultzmann has invented a urethral dropper for ap- 
plying any astringent fluid or caustic to deeper por- 
23 



354 SEXUAL IMPOTENCE 

tions of the urethra. A physician handling the en- 
doscope can dispense with these instruments in the 
treatment of impotence if no special obstacle inter- 
fere with its introduction. Any difficulty in the in- 
troduction of the endoscope will also interfere with 
the introduction of the other instruments, except- 
ing cases where an exceedingly narrow urethra is 
the only obstacle. 

Zinc, alum, copper, or tannin may be used in the 
urethral injections. I especially recommend tinc- 
tura ratankice, which can be used in solutions of dif- 
ferent strength. One drop of pure tinctura rat an - 
hise (Krameria triandra) on the pars prostatica has 
the same effect as one cauterization, without any 
of the objectionable consequences that follow the 
latter procedure. Recently I obtained remarkable 
results from local applications of fuchsin solutions. 
Weak solutions of fuchsin and of the various astrin- 
gents can be injected with any ordinary urethral 
syringe. Stronger solutions had better be applied 
locally under the safe guidance of an endoscope. 

Very good results are obtained in certain cases of 
impotence that accompany chronic gonorrhea and its 
complications by the use of intravesical irrigations. 
These can be performed thoroughly and easily with 
Valentine's intravesical irrigator. 

The introduction of flexible bougies or metal sounds 
may be indicated in a great many cases, and was 
advised by Lallemand. Special results are obtained 
in hyperesthetic conditions of the urethra and the 
prostata. In some cases the introduction of a bougie 
or sound is accompanied by so much pain that the 



TREATMENT 355 

patient can with difficulty be induced to submit to a 
second introduction. 

In cases of intense hyperesthesia it is best to begin 
with the insertion of flexible bougies as gently as pos- 
sible. If the procedure is repeated daily, the hyper- 
esthesia decreases markedly and gradually admits of 
the use of metal sounds. This would show that the 
treatment by sounds or bougies is of particularly 
good effect, especially in cases of precipitate ejacu- 
lation and of too frequent pollutions. The idea is 
probably quite correct that by the introduction of a 
heavy metal sound pressure and tension are pro- 
duced in the pars prostatica, thus causing a stimula- 
tion and possibly an erection, * but this is of no par- 
ticular value in the course of the treatment of impo- 
tence, because it soon loses its effect. In certain cases 
it may be useful as a temporary harmless excitant. 

For many years I have almost exclusively used 
metal sounds, because experience has taught me that 
after sufficient dexterity is acquired it is easier to 
insert a steel sound than a flexible bougie in cases 
of intense hyperesthesia. When using a metal 
sound force is, of course, to be avoided, and the 
sound must be guided by the anatomy of the parts, 
and must be carried practically by its own weight 
into the bladder. In withdrawing the sound the free 
hand must take hold of the penis close to the meatus, 
and by gentle downward pressure protect the urethra 
from strain that might be induced by the escaping 
sound. 

1 Ultzmann, Ueber Potentia generandi und Potentia coeundi, 
Wiener Klinik, 1885, Heft 1. 



356 SEXUAL IMPOTENCE 

Many authors and most practitioners recommend 
external applications to the genitalia of various sub- 
stances, such as tinctura nucis vomicae, eau de Col- 
ogne, alcohol, etc. It is not to be denied that such 
applications increase for the time being the vascular- 
ity of the parts in question, and that the cutaneous 
nerves may thereby be temporarily excited. At 
any rate, the effect cannot be great, and therefore 
they may be ordered sometimes "ut aliquid fiat," 
especially in cases when the patient's uneasiness 
must be appeased. Concerning the tinctura nucis 
vomicae recommended by Roubaud, 1 it would be in- 
teresting to ascertain whether some of it is absorbed 
through the skin of the glans. The late eminent 
surgeon C. Stinson, 2 of San Francisco, unfortunately 
one of the few persons killed by the earthquake in 
1906, took the effect of local applications of a fluid 
preparation of Echinacea angustifolia somewhat too 
seriously, and thought to have discovered " a new and 
successful aphrodisiac for impotence." I am really 
sorry to state that this, as he said, "mildly stimulat- 
ing non-toxic antiseptic, antizymotic, alterative, 
anodyne, restorative, and aphrodisiac" accomplishes 
certainly no more than an application of alcohol or 
tincture of nux vomica. 

We cannot approve of the application of sinapisms 
to the genitalia as recommended by Roubaud; be- 
cause the least incautious management may do harm, 
and because no benefit can be derived from an erec- 
tion produced by such a painful remedy. 

!Op. cit., p. 154. 

2 New York Medical Journal, Jan. 13, 1900. 



TREATMENT 357 

We do not mean to waste more than a word here 
on acupuncture and electro puncture. They were for- 
merly in use; were recommended by Lallemand, 
and later by Roubaud ; but no one nowadays would 
entertain the idea of indulging in such a procedure. 

Local surgical operation must of course be adopted, 
when possible, for the removal of defects. The most 
frequently indicated operations are circumcision and 
the gradual dilation of strictures. Circumcision is 
certainly indicated more frequently than executed. 
Many cases of neurasthenic impotence, nocturnal enu- 
resis and even annoying acne can be relieved by this 
simple operation. 

The resection of the dorsal vein of the penis has 
been suggested some years ago. Lydston 1 reported 
that he was unable to secure as satisfactory results 
from this operation, as other more enthusiastic 
advocates. Still he claims 25 per cent, of the prop- 
erly operated cases giving perfect satisfaction, in 
about half the remaining cases some improvement, 
failures for the rest. I have never seen the slightest 
effect of this operation, and agree fully with Lydston 
when he says that many of the sudden and complete 
cures probably were but cases of psychic impotence 
in which "an alleged operation upon the dorsal vein 
of the penis would be likely to be equally efficacious 
with the genuine article." Better results would 
certainly be obtained were it possible to remove the 
vena profunda penis, which carries the bulk of the 
venous blood from the corpora covernosa. 

Kreissl 2 obtains good results from epidural injec- 

1 Med. Standard, 1901, p. 391. 

2 Urogenital Therapeutics, Chicago, 1908, p. 433. 



358 SEXUAL IMPOTENCE 

tions. My experience with them is limited to 
several cases of spinal and cerebral syphilis in 
which I used the Swift-Ellis treatment, and saw, 
along with other favorable results, in some cases 
also an improvement of the sexual power. 

The application of massage, general as well as 
local, gymnastics, and, above all, systematic deep 
breathing may in many cases of impotence bring 
about very satisfactory results, especially when it is 
necessary to strengthen the body and to further as- 
similation and elimination. 

General massage of the body, the Swedish move- 
ments, and our ordinary gymnastics can be used only 
with reasonable moderation. I do not think, how- 
ever, that systematic exercise, even if carried to ath- 
leticism, can in any wise have an unfavorable influ- 
ence on the sexual power, as is often stated. If 
some athletes are really disinclined to enjoyments in 
venery, the explanation is found in the fact that an 
occupation monopolizing time and causing bodily fa- 
tigue is not conducive to sexual pleasure. I have 
known some athletes who by no means despised sex- 
ual enjoyments. The idea that athletes are weak 
sexually probably arose from the fact that among the 
ancient Grecians all athletes were compelled to ab- 
stain from coition as much as possible. 1 

Substitutes for gymnastics proper are such other 
bodily exercises as riding, skating, etc. ; and bicycling 
is to be recommended particularly. Lallemand has 
said, "The action of the lower limbs has probably 

i Busch, Allgemeine Orthopadie, Gymnastik, und Massage, 
Ziemssen, Allg. Therap., Band ii, Theil 2, p. 20. 



TREATMENT 359 

more of a direct influence upon the sexual organs." 
Of course, even these exercises must not be carried to 
the point of fatigue. 

When most authors condemn horseback riding as 
being injurious for all those afflicted with any genito- 
urinary disease, then they are simply trying to per- 
petuate old established prejudices, copying erroneous 
statements that go from book to book, and give con- 
clusive proof that they know very little or nothing 
about the question. Of course, like any other 
athletic exercise, horseback riding is injurious to va- 
rious organs if done improperly. The rider who 
depends on his balance instead of upon a firm clutch 
of his legs, who rides with the stirrups low, cultivat- 
ing exclusively a sitting trot, trembling like 'a jelly- 
fish, hitting the saddle with his perineum, rubbing 
and knocking his sexual organs against a high and 
hard frontal knob, or the other fellow who trying to 
ride the rising trot does what is usually called bounc- 
ing, have to blame themselves if they feel bad conse- 
quences. Riding properly done is not contraindi- 
cated in any genito-urinary disease where absolute 
rest is not required. 

Dr. Clifford Mitchell of Chicago obtains good re- 
sults in cases of ' neurasthenic impotence ' by persis- 
tent bicycle riding, about ten miles a day, and pre- 
sumes that horseback riding is also useful. 

The long suffering public, pedestrians and horse- 
back riders, who can never tell when a drink and 
speed-crazy hoodlum in an automobile is going to 
crush the life out of them, may feel some satisfaction 
by knowing that motorcar speeding causes sexual 



360 SEXUAL IMPOTENCE 

impotence. I suspected this fact years ago, but did 
not dare to trust my own observations, fearing that 
my wish was the father of my conclusions. But 
then came such a careful and reliable observer as 
Notthaft 1 and reported four cases of sexual im- 
potency in wealthy married men fond of auto- 
mobile speeding and one in a chauffeur. Notthaft 
knows of similar cases in the experience of others. 
The sexual depression developed from three months 
to three years after special devotion to the sport. 
Notthaft ascribes the impotency to a cerebral neuras- 
thenia from the nervous strain of the speeding. The 
intense concentration of mind required in speeding, 
the anxiety and the jar of the car — all tend to in- 
duce neurasthenia. 

1 think, however, that the jar of the car and the 
bouncing upon the soft and warm upholstery are the 
chief harmful influences, because the speeders that I 
have so far observed certainly had no mind worth to 
speak of to concentrate on anything. 

An occasional massage of the genital region after 
Zabludowski's 2 method gives good results in some 
cases, but would be contraindicated where we have 
to deal with any symptoms of irritable weakness. 

Gentle and careful massage of the testicles is in- 
dicated and very useful in premature senile im- 
potence. It positively increases the blood-supply 
and, consequently, the semen-producing activity of 

1 Zeitschrift fur Urologie, April, 191 1. Journ. Am. Med. Assoc, 
May 20, 191 1, p. 1519. 

2 Therapy of Impotence in the Male. Journal of Cutaneous and 
Genito-urinary Diseases, March, 1900. 



TREATMENT 36 1 

these organs. Intelligent patients .may eventually 
be instructed to act as their own masseurs. 

In some cases traveling may have marked effect. 
An interesting journey, and especially if made on 
foot, in part at least, is beneficial; it engages the 
mind and draws the patient away from bad company 
or from undesirable conditions. Many patients have 
returned perfectly cured from a proper journey. 
Sea voyages also, if not of excessive length, do very 
excellent service in proper cases, and especially in 
those where temporary abstinence is positively in- 
dicated. 

The flagellations that were known in ancient times, 1 
and at one epoch enrolled in religious service, 'la 
Discipline d'enhaut et la Discipline d'enbas," 2 are 
in some sense a kind of massage. They are appro- 
priated in our days by physically ruined debauchees 
as a means of stimulating the exhausted spinal cord. 
Ancient authors have a peculiar explanation for the 
stimulating influence of flagellations; for instance, 
Boileau: 3 "Cela pose, il faut de toute necessite, que 
lors que les muscles lombaires sont frapez a coup de 
verges, ou de foiiet, les esprits animaux soient re- 
poussez avec violence vers l'os pubis, et qu'ils exci- 
tent des mouvements impudiques, a cause de la 
proximite des parties genitales: Ces impressions 
passent d'abord au cerveau, et y peignent de vives 
images des plaisirs defendus, qui fascinent l'esprit 

1 Roubaud, op. cit., p. 151. 

2 Histoire des Flagellars, traduite du Latin, de M l'Abbe Boileau. 
Amsterdam, 1701, p. 5. 

3 Histoire des Flagellans, p. 307. 



362 SEXUAL IMPOTENCE 

par leurs charmes trompeurs, et reduisent la chastete 
aux derniers abois." 

Our explanation of the effect of these flagellations 
differs considerably from the above. Besides, we 
must dispense with these means of treatment. In 
some cases we may apply along the spine different 
aromatic and irritative substances, which cause a 
local hyperemia and are good substitutes for the fla- 
gellations. We shall take no notice of urtication, 
moxa, vesicatories, and similar things. 

Albert Abrams 1 inaugurated a new method of 
treatment by concussion of the region over the 
eleventh and twelfth dorsal vertebrae. According to 
Eckhard erection is mediated by the nervi erigentes, 
stimulation of which causes a dilation of the ar- 
terioles in the erectile tissue of the penis with an in- 
creased flow of blood. These nerves arise from the 
sacral portion of the spinal cord which corresponds 
to the spines of the vertebras mentioned above. 

While at first rather incredulous, I have seen such 
startling results from the concussion (not vibration) 
of the various bodily regions, mainly over the verte- 
brae, that I feel justified in recommending that a 
trial be given to this method in all cases where it can 
be supposed that nerve-centers are in need of stimu- 
lation. 

Professional and other inventors have always en- 
deavored to construct apparatus and instruments 
designed either to remove sexual impotence itself or 
to enable the impotent to introduce the non-erected 
or only partially erected penis into the vagina. T 

1 Spondilotherapy, Philopolis Press, San Francisco, 1910. 



TREATMENT 363 

refer here to the paradoxical apparatus for the pre- 
tended enlargement of the penis by Roubaud, who 
has found no imitators; to the so-called "ventouse" 
by Mondat, mentioned also by Roubaud; and to 
numerous other devices that are almost useless. 

The first step in a practical direction was made by 
an inventor unknown to me, who constructed a small 
instrument in which a flourishing trade was carried 
on for a while, and which I described in the first edi- 
tion of my " Pathology and Therapy of Sexual Impo- 
tence" (1889). There existed at that time also 
medical moralists who declaimed against such instru- 
ments; but, in spite of this, I was confirmed in my 
opinion, expressed at that time, that even a con- 
scientious physician in cases especially worthy of re- 
gard, and when every other remedy had failed, could 
take upon himself the responsibility of advising the 
use of such an instrument. Shortly after the appear- 
ance of my work, letters from every part of the world 
came to me from physicians inquiring concerning the 
instrument, which was ample proof for me that such 
an apparatus was in demand. 

The instruments were made of German-silver, sil- 
ver, or gold, and consisted of two delicate splints con- 
nected at the base by a metal ring, and at the upper 
end by a soft-rubber ring. In the jargon of elderly 
bon-vivants it used to be called "the sledge," and 
fairly fulfilled its purpose, when made exactly to 
measure, in spite of considerable inconvenience aris- 
ing from the fact that the penis was not supported at 
the base, and that the instrument certainly could not 
remain unnoticed and unfelt by the female partner. 



3^4 SEXUAL IMPOTENCE 

The various chains, belts, plates, and other con- 
trivances which, as Fiirbringer says, bring to mind 
the amulets of old, we shall not consider at all, as 
they are calculated solely to abuse the ignorance and 
credulity of the masses, and are of greater utility to 
the rascally vender than to the gullible purchaser. 

A real progress in the direction of the mechanical 
treatment of sexual impotence began with Paul Gas- 
sen's devices, and while his instruments are no more 
up to date, because surpassed in efficiency by newer 
inventions, we shall quote the opinions of Krafft- 
Ebing and others because they explain the motive, 
object and principle of such appliances in general. 
Gassen's " erector' ' consisted of a doubly coiled 
spiral provided at both ends with knob-like masses. 
The instrument was to be twisted round the mem- 
ber in such a manner that the greater button-like 
extremity was placed in the region of the anus, the 
smaller one on the right side of the frenulum. The 
first turn, consequently, was placed on the dorsal 
side of the basis of the penis, enabling it to exercise 
pressure on the vena dorsalis, thus possibly checking 
the reflux of blood from the corpora cavernosa. 

The interest of European physicians for these in- 
struments was awakened through Krafft-Ebing's 1 
expert opinion, as well as Fiirbringer 's 2 article in the 

1 Gerichtliches Gutachten iiber ein von dem Techniker Paul 
Gassen erfundenes Instrument zur Behebung der Impotenz, 
genannt Erector. Friedreich's Blatter fur gerichtliche Medicin 
und Sanitatspolizei, 1897, Heft 3, p. 217. 

2 Zur diatetischen und physikalischen Behandlung der Impo- 
tenz. Zeitschrift fur diatetische und physikalische Therapie, 
1808, Band I, Heft 1. 



TREATMENT 365 

"Zeitschrift fiir diatetische und physikalische Thera- 
pie," and numerous experiments on the subject 
followed. 

Krafft-Ebing, in his well-known opinion, given as 
an expert before the royal court of justice of Cologne, 
said, among other things: "Paul Gassen's erector is 
in general adapted to afford the results claimed for 
it in the circular, in spite of this being too full of 
self-praise, in so far as it promotes the erection, and 
gives to the penis at least part of the rigidity requisite 
for the inimissio in vaginam." Further: "Condi- 
tions of absolute impotence are, however, rare, and 
are caused only by severe vertebral and nervous dis- 
eases. In medical practice we have, in a vast major- 
ity of cases, to do merely with relative impotence 
through physical causes (exhaustion as a consequence 
of excesses of individuals who have abused the 
natural sexual pleasures or in consequence of onan- 
ism) or psychical (imaginary obstacles, fear of 
failure, etc.). Here a considerable or virtually the 
full power has been preserved, and the erector may, 
in the first case, compensate for the failing remainder 
of power, and afford, as it were, a crutch for the lame ; 
in the latter case it acts, in combination with its me- 
chanical action, psychically, and, awakening the con- 
fidence in the required capacity, it compensates for 
the imaginary obstacles called forth by the mistrust 
of his own power, under circumstances preventing 
erection; just as, for example, any one suffering from 
agoraphobia, being in this psychical anomaly incapa- 
ble of crossing a square, is enabled to do so when ac- 
companied at starting merely by a child. 



366 SEXUAL IMPOTENCE 

"The inventor of the erector, in his circular, had in 
view as a layman merely the mechanical effect of 
his instrument, and those debilitated and enervated 
through sexual abuse. He had no idea that there 
are very many sufferers with impotence who are so 
from no fault of theirs, through psychical influence, 
and only requiring psychical aid. 

" In so far, however, as the instrument is adapted, 
in cases of merely relative impotence, to accomplish 
important ends, at least to facilitate the sexual act 
mechanically, it gives a quasi-guaranty of the result 
in the case of the psychically impotent, and frees him, 
through the success attained, of his psychical obsta- 
cles, and thus renders him absolutely able. In this 
respect we might even speak of a (psychical) cure 
through the erector. 

" As the potentia cceundi is a necessary condition 
for the potentia procreandi, the erector appears even- 
tually also adapted for insuring the latter capacity. 

"As, however, the instrument essentially facili- 
tates the conditions for the accomplishment of coitus, 
impotence being for the one who suffers from it a 
physical and psychical evil, its use, rendering possi- 
ble, as it does, the accomplishment of a function 
natural and important both for the body and for the 
soul (psyche) , can in general operate only favorably, 
except in case one is misled by the artificial contri- 
vance to excesses in coitus — a circumstance, how- 
ever, which should not be attributed to the instru- 
ment, but to the wearer. 

" In view of the very great frequency of impotence 
in modern society, and the significance of this evil for 



TREATMENT 367 

those who suffer from it, as well as the imperfection 
of medicinal and physical remedies, the fact is read- 
ily understood that mechanical expedients have long 
ago been devised by physicians to come to the aid of 
failing or weakened power." Further: "Paul Gas- 
sen has, as we see, scientific medical predecessors in 
the domain of invention of mechanical contrivances 
for the removal of impotence, and the need of 
such will always exist, since, on the one hand, the 
medicaments at our disposal are only exceptionally 
able to cure impotence, and, on the other hand, the 
most important interests of patients are at stake: 
health, fitness for marriage, capacity for procreation, 
and, in the negative case, bodily and mental disease, 
suicide, adultery, etc. 

"Accordingly, Paul Gassen's erector appears at 
the present time as the best expedient for the im- 
provement and attainment of sexual capacity for all 
who are in the sad condition of needing the service of 
such mechanical contrivances, and medical science 
would have been under obligation to the inventor if 
he had placed his invention at the disposal of its 
representatives for trial and application, instead of 
making it from the start an object of advertisement 
and mercantile enterprise." 

Furbringer also thought that Gassen's erector must 
be considered an instrument constructed on rational 
principles, when used under proper circumstances. 
In a simple and ingenious manner it has completed 
the principle of the "sledge," under the form of an 
elastically flexible serpentine coil in such a manner 
that opposite to each point of pressure there is a cor- 



368 SEXUAL IMPOTENCE 

responding point without such pressure. Preven- 
tion of natural erection in any way is accordingly 
excluded. Furbringer joined also in the view of the 
two medical experts who, together with Krafft- 
Ebing, expressed themselves in those court trials, 
that by means of the erector the erection may be 
maintained after ejaculation. 

Lowenfeld 1 was of the opinion that the use of 
these instruments should be limited to a very small 
number of cases, and warns against their use when 
patients are suffering from any "irritable" form of 
impotence, or from premature ejaculation in conse- 
quence of an irritable weakness of the lumbar sexual 
center. 

My own experiences with Gassen's apparatus 
were, with respect to the erector, almost in harmony 
with the views just quoted. The erector, when made 
according to correct measurement, supports the 
member so that it can be introduced into the vagina 
when partial erection is present. Through the move- 
ments of coitus thereby rendered possible the erection 
is augmented or even completed in cases where this 
is possible at all, and a gradual vanishing of the 
erection, as usually happens in so many cases of 
neurasthenic impotence, is mostly prevented. 

Gassen's compressors are no new idea; similar ex- 
pedients were known to me years ago, but his com- 
pressors are preferable to the formerly used annular 
compressor, because they are easily put on and 
quickly removed. The compressors are hardly ca- 
pable by themselves of causing an erection, but they 

1 Therapeutische Monatshefte, Feb., 1898. 



TREATMENT 369 

can maintain and increase an already existing partial 
filling of the cavernous tissue, exerting, as they do, 
the necessary pressure to check the reflux of the ve- 
nous blood, but not compressing the arteries. 

The suction-pump called by Gassen the "cumula- 
tor" can, in particular and very rare cases, be used 
for a kind of gymnastics of the erectile tissue. It is 
new in execution, but the principle is old. 

Considering the experience I have had with "the 
sledge," we must assume that the erector could bring 
aid in some cases of impotence. When I remember 
the case communicated by me at the time in which 
a psychically impotent young man was able to ac- 
complish copulation only when he had the so-called 
"sledge" as a surety with him, without, however, 
ever really making use of it, it is to be expected that 
neurasthenic impotence will furnish a good field for 
these mechanical remedies. 

Another of Gassen's instruments, the so-called 
''ultima" was in many ways the predecessor of Wil- 
liams' penile splint, and of another more recent 
German invention called Hercules, which accom- 
plish more than any other mechanical device in- 
vented up to date. Because the penis, with excep- 
tion of the glans, is encased in a flexible rubber 
mantel, it might meet with prejudice and be ob- 
jected to. I do not hesitate to advise the use 
of this kind of a last refuge in cases of incurable, 
paralytic, or senile impotence, where there are no 
erections but the seminal fluid is in normal condi- 
tion, and the begetting of a child is ardently de- 
sired. 
24 



37© SEXUAL IMPOTENCE 

The penile splint, devised by Dr. Triad. W. Wil- 
liams, and the so-called hercules are really practicable 
and enable the introduction of the non-erected penis 
into the vagina under all circumstances. Acting as 
a suggestive safety-valve they may be considered a 
legitimate therapeutic measure in neurasthenic and 
so-called psychic impotence. 

In the treatment of most forms of impotence spe- 
cial weight must be attached to the regulation of the 
sexual life. Here also we must carefully consider 
the form of the disease, as well as the constitution 
and general disposition of the patient. There may 
be cases in which the physician is compelled to order 
absolute continence, in accordance with what we 
have previously stated on this subject. This advice 
will generally be indicated only in those cases in 
which the patient is to be convinced that he is in 
reality not impotent. 

Generally, however, the physician will find it nec- 
essary to order the patient to have regular inter- 
course, and this advice may have to be given some- 
times from the very beginning, sometimes later in 
the course of the treatment. The medical man 
must feel it incumbent upon himself to do his duty 
conscientiously and according to his best knowledge, 
even though he may fail to sustain his "dignity." 
The times have gone by when the doctor walked 
along gravely adorned with his doctorate's hat, his 
stick, and his periwig; they have gone by together 
with the periwig and the pigtail. It is well that they 
are passed, and it is to be hoped that they are forgot- 
ten. In our days we wish to advise and help the 



TREATMENT 371 

sick. Our dignity does not suffer if we order regular 
sexual indulgence. 

I notice with very much satisfaction that I am not 
alone in my ideas upon this subject, the expression of 
which, about twenty and some years ago, earned for 
me so much adverse criticism. Prince A. Morrow, 1 
for instance, says, " The exercise of the sexual organs 
within certain bounds undoubtedly has the effect of 
strengthening, invigorating, and preserving them in 
their full integrity." 

There is many a case treated and maltreated with 
all kinds of local applications, milked and massaged, 
where regular sexual intercourse, sometimes even a 
pseudo-excess, would accomplish all that is necessary. 

The ampullae, the vesiculae seminales, the prostate, 
and other neighboring glands are sometimes filled 
with the products of their secretion. The result is 
hyperemia and its consequences. Lohenstein thinks 
that the secretory activity of the prostata is increased 
by retention of the products of the testicles in these 
organs. Whenever a physician finds a case where 
he thinks milking of the seminal vesicles or massage 
of the prostata were indicated, he can safely order 
regular and if possible repeated sexual intercourse. 
The natural way of emptying the sexual glands is 
contraindicated only in cases where gonococci cause 
a florid inflammation, but in such cases a physician 
with any capability of judgment will also refrain 
from massage. 

In rare cases where gonococci are in a latent con- 
dition, but located in the prostata or even higher, 

1 A System of Genito-Urinary Diseases, vol. i, p. 1003. 



37 2 SEXUAL IMPOTENCE 

our only chance to dislodge them is in a thorough 
and repeated emptying of all the sexual glands. 
This can certainly not be accomplished by massage 
or milking, but only through natural and if possible 
vigorous contractions. Of course, in such cases we 
must insist upon the use of a good condom, to guard 
against propagation of the disease. 

Especially I must warn against imposing absolute 
and prolonged continence upon so-called elderly men. 
The sexual desires and powers of a man over fifty are 
easily put to sleep, and it may subsequently prove 
impossible to arouse them again. A rest of one week 
is the longest I ever exact, though longer intervals 
may be suggested in cases where an older man lives 
with a young wife, and where we order abstinence, 
knowing in advance that the first real desire, associ- 
ated with a proper erection, will be the signal for the 
breaking of our commandment. 

Regular sexual intercourse may be easily advised, 
but is a very serious question with the patient. As a 
rule, the physician can relatively do no more than he 
does when he prescribes for an anemic, neurasthenic, 
or exhausted pauper nourishing food, rest, fresh air, 
proper clothing, amusements, baths, and calisthen- 
ics. The hope that the fittest will survive is all that 
is left to us; but even on this question the doctor 
may not refuse advice, especially when he is rendered 
competent by knowledge of medicine and the 
world. 

Whenever regular sexual intercourse seemed neces- 
sary physicians have, in all times, advised marriage. 
Now, marriage is a delicate and important affair. 



TREATMENT 373 

Still, I do not entertain the views of those authors 
who will not admit that matrimony should be ad- 
vised from the therapeutic standpoint. I believe 
that matrimony is a contract in which one party 
agrees to give something for something to be obtained 
in return. Of course, if marriage is considered "an 
immortal relationship," 1 then it were necessary to 
wait until in heaven to take advantage of the bene- 
fits of this relationship. It is a serious matter to ad- 
vise matrimony, for no physician wishes to carry on 
his conscience the misfortune that may arise from 
another man's matrimonial venture. It must, how- 
ever, be admitted that marriage with a suitable per- 
son is the safest and most reliable remedy for many 
forms of impotence, and it serves also as a great pre- 
ventive against the contraction of impotence. On 
the other hand, most patients object* to matrimony. 
Many even have an aversion for marriage in general, 
and think they have sufficient reason for their belief. 
In such a case the physician will, of course, not insist 
on his advice. Others, again, dare not venture to en- 
ter into matrimony because they believe themselves 
to be unable to fulfil their conjugal duties. If the 
physician finds this to be true, there is again every 
reason for not advising matrimony. 

A man who is even moderately virile had better be 
dissuaded from marriage, because his sexual weak- 
ness would render his hymeneal happiness doubtful 
unless he should happen to find a wife not particu- 
larly given to sexual pleasure. Here very great dis- 
cernment and caution should prevail, because such a 

1 James Foster Scott, op. cit., p. 95. 



374 SEXUAL IMPOTENCE 

quality is not to be read on the forehead or face, of a 
woman. See here the beautiful diplomatic language 
with which Rosenthal 1 expresses his opinion: "In 
case of recovery or lasting improvement in the sexual 
power, a subsequent marriage to a person of calm 
temperament may be allowed in order to preserve the 
restored condition." 

Lydston, 2 as usually, hits the nail squarely on the 
head when he says: "Marriage is too easy, divorce 
too difficult for the physical and moral welfare of 
mankind. Marriage should at least be as difficult to 
enter as it is to escape from." 

As marriage is a heroic and very dangerous rem- 
edy not accessible to every one, and as a mistake in 
this affair is so difficult to correct, many a conva- 
lescent patient will be compelled to have recourse to 
other connections than hymeneal in order to satisfy 
his sexual desire, if he does not want to become im- 
potent again or to be troubled again by morbid pollu- 
tions. He must satisfy this natural want regularly, 
and the act cannot be called immoral simply because 
it is accomplished out of wedlock. Such connections 
may be unknown to dried-up pedants who have never 
been young, but every man gifted with a heart and 
physical power is familiar with these liaisons in all 
their variations. 

An individual weak in sexualibus is seldom lucky 
enough to captivate a woman's heart, and prostitutes 
are his only recourse. Modern prostitution is, as 

1 Ueber den Einfluss von Nervenkrankheiten auf Zeugung und 
Sterilitat. Wiener Klinik, 1880, Heft 5, p. 141. 

2 Op. cit., p. 623. 



TREATMENT 375 

Mantegazza 1 expresses it, "The product of the 
Christian virtue, which wants a perfect man, and the 
animal instinct, which drives the man into a woman's 
arms." 

We must consider that the functional capacity in 
intercourse with a prostitute is not in proportion to 
the actual sexual power, and that real prostitutes — 
i.e., those "whom any one can buy" 2 — are too re- 
pulsive to please the good taste of some patients. 
Again, we must consider the dangers of venereal 
diseases. 3 

It is obvious that a physician can in these matters 
give little advice to his patient, but must entrust 
him to good luck. Besides, when the physician has 
done his duty toward an individual and cured him 
completely or partially, he can generally yield him to 
his fate with tranquillity, because most of the sex- 
ually weak persons who take medical advice are of 
the intelligent and well-to-do class of society. 

The sanguine hopes that were entertained once 
about the result of inhalations of oxygen have proved, 
by thorough investigation and experiments, to be a 
mere fata Morgana. Sometimes, however, this rem- 
edy may be given a trial, because it may be bene- 
ficial, and especially in cases complicated with 
anemia, leukemia, diabetes, dyspepsia, and chronic 
weakness. 

The therapeutics of impotence has been greatly 

1 Gli amori degli uomini. Milano, 1886, vol. ii, p. 201. 

2 Jeannel, De la prostitution. Paris, 1874, p. 190. 

3 For fuller information see: Vecki, Prevention of Sexual 
Diseases. Critic and Guide Publ. Co., New York, 19 10. 



376 SEXUAL IMPOTENCE 

enriched by Motschutkovsky, who, while applying 
Sayre's corset, noticed that the body lengthened 
during suspension. Repeated measurements proved 
that this lengthening is due to the stretching of the 
vertebral column, and varies between two and one- 
half and five centimeters. This led Motschutkovsky 
to the idea of trying suspension in diseases of the 
spinal cord. The result was excellent: several 
troublesome symptoms vanished during the treat- 
ment. Of chief interest for us in this experimenta- 
tion is the circumstance that in every case a certain 
number of suspensions removed all the preexisting 
disturbances in the sexual feelings and power. In 
Charcot's clinique at Paris the same fact was estab- 
lished, along with decided improvement in func- 
tional diseases of the bladder, so often accompanying 
tabes ; and also the cure of neurasthenic impotence. 
Bernhard reports a case in which, after nineteen sus- 
pensions, erection and pollutions reappeared after 
having been absent for over a year. 

I have treated with suspension numerous patients 
threatened with paralytic impotence, and in several 
cases obtained considerable improvement. After a 
few suspensions erections and libido partially re- 
turned. I never noticed lasting results, however. 
Everything returned to the old state a few days after 
the cessation of the suspensions, and, moreover, the 
suspensions themselves lost their efficacy after a few 
weeks. These suspensions in paralytic impotence 
may be compared to one of the last lashes given to a 
jaded beast of burden. 

Since, however, suspensions have had some effect 



TREATMENT 377 

on paralytic impotence, a disease in which therapeu- 
tics is usually powerless, it was certainly to be ex- 
pected that they would produce better, or even sat- 
isfactory, results in forms of impotence that are 
easier to cure. Indeed, I have obtained very favor- 
able results, and sometimes a perfect cure, in various 
cases of sexual neurasthenia. 

One of these cases, which I published at the time, I 
shall reproduce here. A lawyer, thirty-four years 
old, somewhat thin, though always healthy, had in 
his youth passed through his experiences with onan- 
ism. After that he was on intimate terms for six 
years with a woman two years his senior. During 
this entire connection he never experienced any signs 
of impotence, for he was all that time able to accom- 
plish the act to his heart's content. In the rare 
intercourse he had with prostitutes during those six 
years he had a few failures in coition, but did not at- 
tach any importance to them. For five weeks before 
he applied to me he had vainly endeavored to ac- 
complish coition, although his opportunities had 
been most favorable and the responsiveness of his 
companion all that could be desired. Hence he was 
in a state of great excitement and believed himself to 
be quite and permanently impotent. After a fruit- 
less attempt with nux vomica I proceeded to the use 
of suspensions, after having represented them to be a 
sure and infallible curative remedy. I was informed 
by the patient that he had erections in the night fol- 
lowing the first suspension, and after the fifth he 
accomplished coition without my permission, and he 
assured me he did not need further medical treat- 



37 8 SEXUAL IMPOTENCE 

ment. After the ninth suspension I dismissed him 
from my care. 

Although the result was satisfactory in this case as 
well as in many others, I was not convinced that 
these suspensions had an aphrodisiac power, because 
I knew that psychically impotent persons are some- 
times cured by the most inefficient means. To test 
the suspensions a little further I frequently used 
them on healthy persons. Though imagination may 
have had more or less influence on these persons, 
they asserted that the suspensions had a stimulating 
effect on the sexual desire. 

I tried suspensions in a case of frigidity on the part 
of a married lady. Both she and her husband attrib- 
uted the absence of children to this cause, but an 
examination was refused. Although in this case sus- 
pensions had no effect whatever, I do not contend 
that they have no efficacy in frigidity, which is not 
infrequent in women, and I think further experi- 
ments advisable. In the case just mentioned, I be- 
lieve the wife had an aversion for her husband, al- 
though she assured me to the contrary. 

For these suspensions I invariably use Sayre's ap- 
paratus modified by Motschutkovsky. The act of 
suspending is accomplished gradually and with great 
care. The first suspension never lasts over two 
minutes, but in most cases I have to limit it to one 
minute or less. By degrees, as the patients feel less 
afraid, the duration can be prolonged; but I have 
never gone beyond five minutes, not even when en- 
thusiastic patients requested it. Almost without 
exception they were made every second day. 



TREATMENT 379 

As to the manner in which the suspensions act, we 
must confine ourselves more or less to conjecture. Is 
the cause the momentary change brought about in 
the position of the spinal cord and its nerve-trunks ? 
Is it the tension of the more peripherally situated 
nerves ? Is it the increased pressure of the blood and 
the increased circulation of blood in the vessels of the 
spinal cord, which possibly is caused by the increased 
blood-pressure ? 

Of course, suspension is out of the question with 
persons suffering from defects of the heart, atheroma, 
aneurism, emphysema, cavities in the lungs, inclina- 
tion to hemorrhage from the lungs, epilepsy, apo- 
plexy, also advanced anemia. Every physician 
should devote his attention to these evils before com- 
mencing any treatment for impotence. 

The study of the internal secretion of various 
glands opened before us an enormous field of possi- 
bilities. With hesitation I approached some years 
ago organotherapy. 

When the medical world scoffed at Brown- 
Sequard in 1889 when he dared to come out with 
his " liquid testiculair, " I ventured to give this 
remedy a trial and reported in 1906 as follows: 
My personal experience with Brown-Sequard's liquor 
testiculorum is best expressed in the words that 
Eulenburg 1 uses when he speaks of his own expe- 
rience with Poehl's spermine: viz., "The results 
are varying and unequal, though sometimes sur- 
prisingly favorable without disagreeable collateral 
action." I can even go further and claim that the 

1 Sexal Neuropathic Leipzig, 1895, p. -41. 



380 SEXUAL IMPOTENCE 

results obtained from Brown-Sequard's liquid were 
at my hands always superior to those with Poehl's 
spermine. Invariably I noticed an increase of 
mental and physical vigor, and a considerable im- 
provement in the activity of the spinal centers. 
Such improvement was observed in cases of gen- 
eral prostration and neurasthenia, and what is more 
significant, in the aged and even the paralytic. To 
this I have to add for the present time that I use 
Poehl's spermine only when, as of late, the genuine 
Brown-Sequard's liquid is not obtainable. 

The late Poehl was able to isolate the substance 
spermin, which he thought was the active principle 
of the testicular extract. The present literature on 
this preparation is considerable. G. Hirsch 1 was 
inclined to think that Brown-Sequard's testicular 
emulsion contained both substances, which when 
injected are useful, and substances which have a 
disturbing action on the metabolism. Hirsch tried 
Poehl's spermine in cases of anemia, tabes dorsalis 
and endarteritis obliterans, and by his own obser- 
vations and those communicated to him he had 
arrived at the following conclusions : The spermine 
has no specific action at all in particular diseases. 
It seems, however, to control in some way the met- 
abolism or intra-organic oxidation, and by the re- 
moval of accumulated waste products to disen- 
cumber the nervous system, and so finally to favor 
the vis medicatrix naturse. 

As outlined in the chapter on Physiology, a great 

1 St. Petersburg Med. Wochenschrift, 1897, No. 7; British Med. 
Jour., 1898. 



TREATMENT 38 1 

deal remains unexplained in regard to the properties 
of the living material composing the reproductive 
cells, and we must fully agree with Howell 1 when 
he claims that at present biological investigation 
along these lines is largely in the morphological 
stage. Thus, I am still not ready to go further than 
to state that I have obtained some remarkably good 
results with the internal and hypodermic adminis- 
tration of various glandular extracts, that thy- 
roidin, adrenalin and mainly pituitary extracts 
give excellent results in properly selected cases, but 
that further experiments are imperative, that it 
must be warned against careless use, because dam- 
age is easily done. 

We know now that deficiency of the posterior 
lobe of the pituitary gland is accompanied by a 
condition of sexual infantilism, that the blood- 
pressure is influenced by intravenous injections of 
extracts of the posterior lobe. I have used the ex- 
tract of the posterior pituitary gland in several 
cases of congenital sexual frigidity and weakness 
accompanied by low blood-pressure, and found the 
results satisfactory. 

The main difficulty in using the various biologic 
preparations is in the uncertainty of their pharmaco- 
logical potency and the consequent perplexities of 
dosage. 

The Journal of the American Medical Associa- 
tion 2 claims that "the wide range of physiologic 
activity found in samples of commercial pituitary 

1 A Text-book of Physiology, Saunders, Philadelphia and London, 
1913, p. 944. 

2 April 10, 1915, p. 1250. 



382 SEXUAL IMPOTENCE 

preparations from six prominent manufacturers is 
shown by the ratio of variability between the strong- 
est and the weakest," that "no positive reason can 
at present be assigned for such marked differences in 
activity," and that "the need for uniformity in the 
strength of commercial pituitary products has there- 
by been made the more apparent." 

It is very fortunate that, "realizing that there 
exists at present an ever-increasing demand for 
pituitary products, especially those made from the 
posterior lobe, without there being a generally ac- 
cepted and accurate method of determining their 
activity, the Hygienic Laboratory of the United 
States Public Health Service has taken up the 
problem of pituitary standardization." 

For the time being I am limiting myself to the 
use of the preparations of one reliable manufactur- 
ing firm, and thus hope always to receive prepara- 
tions of almost uniform strength. 

On the whole, a trial with the various organic 
extracts may be ventured; further experiments are 
desirable in order to establish proper indications and 
proper dosage. 

Lydston's experiments on the implantation of the 
generative glands taken from the dead human 
bodies, 1 and his experiments with emulsions of organs 
taken from the dead human body 2 are of immense 
ingenuity and offer possibilities of which we only 
dared to dream. So far we must admire, though we 
lack the courage of following him on this field. 

1 New York Med. Jour., October 17, 24, 31; November 7, 1914. 

2 American Medicine, December, 19 14. 



CHAPTER IX. 

SPECIAL THERAPEUTICS. 

In this section we shall briefly discuss the curative 
methods as they are indicated in the various forms 
and grades of impotence. 

The therapeutics of congenital and acquired mal- 
formations and defects in the sexual organs will be in- 
dicated in each case by an examination, and if any- 
thing is to be done at all, some surgical operation will 
have to be performed in nearly all cases. A timely 
circumcision can accomplish a great deal in selected 
cases, but should never be done just for the sake of 
doing something. The removal of tumors, mainly 
lipomas, and the radical operation of hydrocele may 
remove mechanical obstacles to sexual intercourse. 

Impotence that has come in the track of different 
pathological conditions can be treated only after re- 
moval of these causal conditions, this being accom- 
plished by well known and approved methods. 
Chronic and other diseases of any part of the urethra, 
prostata, vesicube seminales, etc., being mostly con- 
sequences of gonorrhea, must be treated " lege artis, " 
but with moderation. Mild irrigations and careful 
dialations will accomplish more than caustic injec- 
tions and other so-called therapeutic measures, which 
are dreaded by the patient, and always aggravate the 
various neurasthenic symptoms that may attend 
such diseases. 

383 



384 SEXUAL IMPOTENCE 

Goldschmidt's, Buerger's, and other endo-urethral 
knives are, for the time being, the best appliances 
for reaching and destroying cysts or papillomata of 
the region of and around the colliculus seminalis. 
Buerger's cysto-urethroscope and Goldschmidt's en- 
doscopes enable us to locate various inflammatory 
and other lesions, and treat them properly and 
effectively. 

The Oudin current, fulgaration and so-called di- 
athermy with D' Arson val's current are practical 
methods for the removing of various pathological 
conditions in the urethra, but I must, to my sorrow, 
oppose the enthusiasm of some newly made dis- 
coverers. One may go to work and examine hun- 
dreds and hundreds of male urethras, and never 
find a verumontanum that looks exactly as another 
one did; there is as much difference as there is in 
people's noses. You may examine sexually per- 
fectly normal and even extra powerful men and find 
abnormalities, even pathological lesions, and you 
may find a perfectly normal posterior urethra in 
men suffering from various inexplicable forms of 
impotentia cceundi. And after you may have found 
some abnormality or lesion in the proper location, 
and have shouted your "heureka!" and then have 
gone to work and removed it, you may be greatly 
disappointed to learn later that your patient re- 
mained as impotent as before. It takes certainly a 
great deal more than fine technic to obtain thera- 
peutic results in the treatment of such a perplex- 
ing ailment as sexual impotence. It is, however, 
self-understood that pathological conditions in the 



SPECIAL THERAPEUTICS 385 

urethra must be remedied as soon as found before 
any other therapeutic measures are employed. Many 
a time brilliant results are obtained. 

Again I take the liberty of warning against harsh 
treatment of the complicated and delicate structures 
in the deep urethra. The remedy must never be 
worse than the ailment. 

The internal use of some drugs — principally hexa- 
methylenamin and its preparations, uro tropin, hel- 
mitol, but mainly ampho tropin — is frequently in- 
dicated. 

Massage of the prostate gives sometimes good re- 
sults, but regular sexual intercourse, whenever per- 
missible, accomplishes better contractions of all sex- 
ual glands and is preferable to the milking of the 
seminal vesicles, whenever the patient is free from 
gonococci. 

Valentine 1 found that those given to sexual inter- 
course throughout a long life are less prone to senile 
prostatic enlargement than those who led virtuous 
lives. This fact observed during more than a quarter 
of a century of medical practice seemed to alarm this 
genial though careful observer, and, to appease the 
prim ones, he added at once: "Far be it from me 
to even intimate that sexual profligacy may be a 
prophylactic of senile prostatic enlargement." There 
can be a question if those given to sexual intercourse 
throughout a long life always do deserve to be called 
"sexual profligates," but there can be no doubt about 
the fact that among the ailments caused by "sexual 

1 N. Y. Academy of Medicine, Feb. 19, 1902. Journal of Cuta- 
neous and Genito-urinary Diseases, May, 1902, p. 242. 
25 



386 SEXUAL IMPOTENCE 

profligacy" senile hypertrophy of the prostata shines 
singularly by its absence. 

In the treatment of the different variations of hy- 
pertrophy of the prostata which require surgical in- 
tervention the consideration for the patient's future 
sexual capacity is mostly of but secondary impor- 
tance. Retention of urine and other very disagree- 
able symptoms always allied with more or less severe 
pain must be relieved first, and the patient's life 
should be made bearable and if possible prolonged. 
Moreover, these kind of patients are mostly advanced 
in years, and sexual capacity is then of no moment to 
them. However, the physician must always ascer- 
tain, if, and to what extent, sexual ability exists, 
and it is his duty to select a modus operandi which 
will not destroy whatever may be left. Ligation of 
the vas and Bottini's operation being practically 
abandoned we do not have to consider. Joseph B. 
Bissel was kind enough to state to me that none of his 
patients on whom he performed perineal prostatec- 
tomy with drainage 1 have suffered any change as to 
their sexual feelings and ability. 

Wherever it is possible to respect the ejaculatory 
ducts, as some operators claim, we could readily 
understand that the potentia cceundi may remain 
unchanged, and regarding the potentia generandi 
only the finding of motile spermatozoa in the ejacu- 
lated fluid can be of conclusive proof. 

J. Wiener 2 found that suprapubic prostatectomy 

1 The Relief of Prostatic Enlargement. Medical Record, 
Nov. 10, 1900. 

2 N. Y. Med. Monatsschrift, July, 1907, p. 108. 



SPECIAL THERAPEUTICS 387 

gives better results in regard to sexual capacity. He 
observed cases where prostatectomy even improved 
the potentia cceundi, but generally it remains as 
before. 

James E. Moore 1 is of the opinion that the removal 
of the prostate by any route or method is sure to have 
a decided effect on the procreative power of the pa- 
tient. He also emphasizes the reticence and un- 
truthfulness of patients, and that it therefore is im- 
possible to state how often bad sequelae follow. 

In this respect I had a significant personal expe- 
rience. A wine-merchant sixty-four years old on 
whom I performed perineal prostatectomy in 1905, 
boasted to me of his improved sexual power, but his 
wife told me that there "was absolutely nothing do- 
ing." Now, did the man prevaricate or cheat? 

Considering that we mostly have to depend upon 
the patient's statement, it is at least doubtful that 
even the most careful statistics are of great value. 
Young 2 sent letters to all his patients, and, summing 
up the gist of the answers, came to the conclusion 
that "the results obtainable by a conservative per- 
ineal prostatectomy in which the ejaculatory ducts 
and the floor of the urethra are carefully preserved" 
are "that ultimately in about 80 per cent, of the 
cases in which the sexual powers were normal before 
operation they finally become normal after opera- 
tion." Young finds it very interesting "that in quite 
a number of cases in which intercourse was impos- 
sible before operation on account of impaired or ab- 

1 Meeting Am. Surg. Assoc, Phila., June, 1909. 

2 Journ. Am. Med. Assoc., March 5, 1910, p. 790. 



388 SEXUAL IMPOTENCE 

sent erections there has been a complete restoration 
of the sexual powers as a result of the operation. In 
a few instances in which the patient complained of an 
impairment as a result of the operation a urethro- 
scope examination has shown considerable enlarge- 
ment and inflammation of the verumontanum. A 
few applications of the nitrate of silver stick has been 
followed by a return of the erections, and it seems 
probable that decline in sexual vigor is due largely 
to disturbances of the verumontanum as in sexual 
neurasthenias of younger men." 

In perineal prostatectomy Young, however, is in a 
class all by himself, and I am sure that his superior 
skill alone saves many an ejaculatory duct; as a 
rule, the results quo ad potentiam cceundi are better 
if the suprapubic way of operating is selected. 
Freyer, 1 who certainly has the largest experience 
with suprapubic prostatectomy, claims that "there 
is no diminution of the sexual capacity after enuclea- 
tion of the enlarged organ suprapubically . ' ' 

Dr. Henry Meyer of San Francisco, and of intra- 
vesical fame, has perfected an instrument which is 
so constructed that it cauterizes a wide groove in 
the enlarged prostate gland. The cautery-scoop is 
buried into the enlarged prostate gland, in the pos- 
terior urethra in back of the colliculus with the aid 
of a modified Goldschmidt posterior urethroscope. 
The white-hot cautery-scoop is slowly forced into 
the distended bladder, thereby leaving a large space 
for the urine to flow through. With the use of this 
instrument it is not possible to injure the ejaculatory 

1 British Med. Jour., October 5, 1912. 



SPECIAL THERAPEUTICS 389 

ducts, and it immediately makes space for the urine 
to flow through. 

It is very gratifying that the foremost surgeons 
begin to consider the question of preserving the 
"beaux rests" of an eventual sexual capacity in old 
men. When the third edition of this book was pub- 
lished (1901) no one seemed to bother about it. 

Fortunately castration as a remedy for the reduc- 
tion of prostatic hypertrophy has been abandoned. 

If impotence should still remain after the removal 
of all possible causes we must then call into service 
all the stimulating means at our disposal, together 
with a selected diet appropriate for convalescent 
patients. The means indicated then are, first, hy- 
dro therapeutic measures, electricity, high frequency, 
river-bathing, sea-bathing and eventually the in- 
ternal or hypodermic use of strychnin. 

The treatment of inherited sexual weakness is very 
difficult. First of all the sexual desire must be awak- 
ened. This cannot be the business of the medical 
practitioner, but must be left to friends or relatives 
of the patient, who may be advised by the physician. 
After the sexual desire has once been awakened, we 
may proceed to the use of various means of stimula- 
tion in order to arouse the sexual power that possi- 
bly lies dormant, and here organotherapy is most 
useful. Experience teaches that results are not 
easily obtained. Fortunately, sexual weakness of 
a high degree is seldom inherited. 

The medical science is of but little use in the cure 
of perverse sexual sensation. However, education 
or, perhaps, hypnotic suggestion and psychotherapy 



390 SEXUAL IMPOTENCE 

may be of some benefit in all acquired conditions. 
No treatment can be of any use in cases of "im- 
perfect differentiation of sex," and castration may 
be indicated as the only means to save the patient 
from disgrace and keep him out of jail. 

When sexual neurasthenia and impotence have 
been induced by bad management of the sexual 
power, therapeutists must choose various means in 
accordance with the state and physical strength of 
the patient. In every case the treatment must be- 
gin with the regulation of the sexual life, and in some 
isolated cases it may be advisable to order continence 
of moderate duration. It will be proper to order for 
individuals in a declining condition, besides a correct 
diet and certain medicaments, gymnastics, massage, 
hydrotherapeutics, or general electrization and auto- 
condensation of the body. In patients who are 
still physically strong you will find indicated, be- 
sides ordinary food, which need not be too delicate, 
hydrotherapeutics, local electricity, the sound or 
bougie treatment, local injections, cauterization of 
the caput gallinaginis, and, possibly, suspensions. 

As above mentioned, in case onanism or sperma- 
torrhea exists, we must endeavor energetically to cor- 
rect them. 

In the case of impotence originating from con- 
tinence, which, however, is exceedingly rare, it is the 
physician's duty to reawaken the dormant virile 
power; that is, he must stimulate vigorously the 
sexual nerve-centers and tracts that have grown in- 
dolent from want of proper excitation. In this case, 
bad company, which has the reputation of spoiling 



SPECIAL THERAPEUTICS 391 

good manners, may do some good. If necessary, re- 
course may be had to electricity, douches, suspen- 
sions, and local stimulation of the mucous membrane 
of the urethra, especially of the caput gallinaginis.. 

Most of all, purely neurasthenic impotence presents 
numerous difficulties, because an unwise treatment 
may easily do harm. On the other hand, a physician 
who knows how to think will find this a most satis- 
factory field for his action, because good results are 
sometimes more easily obtained than in any other 
form of impotence. A wise, psychical treatment 
does much in such cases, but cannot constitute the 
entire treatment. Neurasthenic conditions cannot 
be cured by simply telling the patient that he is not 
afflicted. Often hypnotic suggestion does very good 
service. 

In so-called irritable weakness we may exercise 
some good influence against precipitate ejaculation 
by toning up the body in general and the sexual 
power in particular. The means suitable for that ef- 
fect are hydro-therapeutics, sea-bathing, river-bath- 
ing, gymnastics, massage, and the psychrophor and 
the sound to lessen the sensibility of the mucous 
membrane of the urethra. Every exciting means 
must be avoided in case the irritable weakness is at- 
tended by intense sexual agitation. 

Edward Martin 1 recommends for the avoidance of 
premature ejaculation, "where the patient is edu- 
cated and has a trained mind, the concentration of 
the latter upon some act of memory, such as recalling 

1 Impotence and Sterility. Hare : System of Practical 
Therapeutics. Philadelphia, 1892, vol. iii, p. 665. 



39 2 SEXUAL IMPOTENCE 

a recitation, or upon some calculation in mathemat- 
ics." I am afraid that such a scheme would work in 
but very few cases, because we know quite well that 
anything which distracts the mind from the sexual 
act is apt to impair the necessary erection. 

I have found that one or two glasses of good beer 
taken before the act very often controls precipitate 
ejaculation. Circumcision is almost imperative in 
all cases where a hyperesthesia of the glans is caused 
by more or less of a phymosis. Very good results 
can be obtained by bathing the glans in a solution of 
tannin in alcohol as Lydston 1 recommends. 

Whenever pathologic conditions of the ampullae, 
vesiculas seminales, the prostate and parts of the 
deep urethra are the cause of ejaculatio precox 
these must be treated lege artis. Massage of the 
ampullae, whenever they can be really reached, fre- 
quently gives prompt relief. 

In other forms of sexual neurasthenia the treat- 
ment will be determined in each instance by such 
causes as can be discovered, and the case may have 
to be treated symptomatically. The frequency of 
intercourse must always be regulated. 

Impotence induced by occupation may also be a 
subject for treatment, but good results can then be 
obtained only when one succeeds in eliminating, or 
at least diminishing, the injurious influences of the 
occupation. 

Genuine senile impotence can never be the sub- 
ject of rational medical treatment, though one may 
sometimes pity an amorous old man. Mechanical 
devices are sometimes indicated. 

1 Op. cit., p. 587. 



INDEX 



Abdomen, pendulous, and impo- 
tence, ii 8 
Ablutions for impotence, 339 
Abrams' concussion, 362 

sphygmobiometer, 268 
Absence of one testicle, 112 

of penis, 97 

of prepuce, 99 

of testicles, 104 
Abstinence, 236 
Abuse of sexual power, 178 

antiquity of, 181 
Acid, phosphoric, 325 

salicylic, virility and, 155 
Acupuncture, 357 

Acute disease, sexual desire in, 114 
Adrenal extract, 381 
Age, impotence and, 89 
Albuginea of corpora cavernosa, 46 
Alcohol, impotence and, 147 
Alkaline waters in pollutions, 311 
Ampho tropin, 385 
Ampulla of Henle, 36 
Amputation of penis, effect, 23 
Anaphrodisia, 314 
Anatomy of male genital organs, 30 
Anemia from onanism, 217 

impotence in, 119 
Anesthesia sexualis, 162 
Animals, perverse sexual feeling 

for, 174 
Antimony, impotence and, 155 
Antipyrin, impotence and, 156 

in spermatorrhea, 313 
Ants, oil of, 324 
Aphrodisiacs, 322 
Apparatus and instruments, 362 
Areolar tissue, compressible, of 

urethra, 45 
Arsenic, virility and, 153 
Arteries of penis, 48 
Artists, sexual feelings of, 255 



Asthma, effect of coition on, 120 
Astringent injections, 353 
Athletics, 358 
Atrophy of prostate, impotence in, 

137 

of testicles from excess, 202 
from onanism, 221 
Atropin in impotence, 326 

in prostatorrhea, 313 
Autocondensation, 305, 390 
Auto-intoxication, impotence and, 

116 
Automobiling, 359 
Azoospermia, Martin's operation 

for, in 
Azperger's rectal cooling sound, 343 



Bacillus, colon, in prostate, 137 
Bacteria in prostate, 135, 136 
Balneological treatment of im- 
potence, 342 
Baths, carbonic-acid, 344 

champagne, 342 

douche-, 339 

half-, 341 

hydro-electric, 347, 348 

in impotence, 336 

lake-, 342 

mineral waters, 342 

partial, for pollutions, 315 

rain-, 339 

river-, 341 

sea-, 341 

shower-, 339 

sitz-, 339 

sponge-, 339 

vapor-, 341 
Beer, impotence and, 148 
Bicycling, 358, 359 
Bladder, absorptive power of, 67 

cystic disease of, virility and, 141 



393 



394 



INDEX 



Bladder, diseases of, virility and, 

i37 

rheophore, 346 
Blood in ejaculation, 199 
Blood-pressure, 119 
Blood-vessels of penis, 47 
Bodily exertion in coition, 191 

fatigue, 254 

structure, sexual capacity and, 88 
Body, effect of impotence on, 25 
Bones, penis-, 114 
Bougies, 354 

Brain, lesions of, impotence in, 121 
Brandy, virility and, 150 
Bromids in pollutions, 313 

impotence and, 156 
Bromo-seltzer, impotence and, 157 
Brown-Sequard's liquor testicu- 

lorum, 379 
Brucin, 326 
Buerger's cysto-urethroscope, 384 

endourethral knives, 384 

urethroscope, 351 
Bulbus urethrse, 45 



Cachexia hypophyseopriva, 146 
Calculs du prepuce, 130 
Calculus, preputial, 130 
Camphor in spermatorrhea, 313 

virility and, 156 
Canals, spermatic, 33 
Cannabis indica, virility and, 153 
Cantharides, 323 
Cantharidin, 323 
Capon-obesity, 20 
Capsule, surgical, of prostate, 39 
Caput gallinaginis, 42 
cauterization, 348 
Carbon-douche, 344 
Carbonic-acid baths, 344 
Castoreum, 327 
Cauterization, local, 348 
Cavernositis chronica, virility and, 

144 
Cells, interstitial, of Leydig, 106 

Sertoli's follicular, 65 
Champagne baths, 342 

impotence and, 150 
Character, effect of impotence on, 

20 
Chlorosis, impotence in, 119 



Chronic discharges, 137 

diseases, sexual desire in, 116 
Cinnamon, 328 
Circumcision, 357 
Climate, 91 
Cocain in impotence, 328 

in pollutions, 316 
Coffee, virility and, 150 
Coition, after-effects of, 190 

bodily exertion in, 191 

difficulty of first, 248 

during menstruation, 277 

ejaculation in, 62 

excess in, 182 

consequences, 193 

frequency of, 182, 275 

frequent, 77 

effect on number of spermato- 
zoa, 79 

loss of substance in, 192 

muscle action in, 193 

nervous system and, 193 

onanism and, 207 

physiology of, 50 

position for, 276 

time for, 275 
Coitus. See Coition. 

interruptus, 75 
Cold applications in pollutions, 315 

dry, in impotence, 343 

severe, impotence in, 119 

water injected into urethra in 
impotence, 343 
Colliculus seminalis, 38, 42 

affections of, virility and, 140 
Colon bacillus in prostate, 137 
Compressible areolar tissue of 

urethra, 45 
Compressors, 368 
Concussion, Ab rams', 362 
Constipation, impotence from, 228 

inciting to onanism, 215 
Consumption, sexual desire and, 

115 
Continence, effects of, 236 
impotence from, 241 
treatment, 390 
Copulation. See Coition. 
Cornutin in spermatorrhea, 314 
Corpora cavernosa, changes in, 112 
fissures in, 113 
penis, 45 



INDEX 



395 



Corpses, defilement of, 176 

Corpus Highmori, 34 

Corpuscles, seminal, 65 

Cortex cerebri, orgasm and, 53, 55 

Cowper's glands, 43 

as sexual organs, 74 
secretion of, and semen, 74 

Cremaster muscle, 31 

Crista urethralis, 42 

Cruelty, 168 

Cryptorchidia, 101, 102 

Cumulator, 369 

Cutis of scrotum, 31 

Cystic disease of bladder and 
urethra, virility and, 141 

Cysto-urethroscope, 384 



Damiana, 329 

Death from excesses, 202 

Defecation, difficult, pollutions 
from, 228 

Descensus testiculorum, 101 

Diabetes, impotence in, 117 

Diagnosis of impotence, 263 

Diathermy, 384 

Diet in impotence, 317 

Digitalis, virility and, 152 

Diphtheritis and impotence, 115 

Discharges, chronic, 137 

Diurnal pollutions, 224 

Dorsal vein of penis, resection, for 
impotence, 357 

Douche, carbon-, 344 
filiforme, 339 

Douche-baths, 339 

Dreams and impotence, 91 

Drugs, 152 

Dry cold, 343 
warmth, 343 

Ductless glands, secretion of, viril- 
ity and, 145 

Ductus deferens, 35 
ejaculatorius, 37 



Echinacea angustifolia, 356 
Ectopia vesicae urinaria^, 103 
Ejaculation, 62 

blood in, 199 

center for, 63 

nocturnal, 63 



Ejaculation, painful, 142 

precipitate, 243 

premature, treatment, 391 
Ejaculatory ducts, 37 
Electricity in impotence, 344 

in pollutions, 312 
Electropuncture, 357 
Endoscope for cauterizing,., 352 
Endoscopes, 384 
Endoscopic examination, 263 
Endo-urethral electrodes, 351 

knives, 351, 384 
Enema in pollutions, 312 
Energy, 173 

Epicures, sexual impulse of, 256 
Epidermis of scrotum, 31 
Epididymis, 34 

parenchyma of, 34 
Epididymitis, effects of, 108 
Epidural injections, 357 
Epilepsy from onanism, 218 
Epileptics, ejaculation and, 164 

perversion and, 169 
Epispadia, 101 
Erectile tissue, defective, 98 
Erection, 57 

beer and, 148 

cause of, 58 

influence on muscles of vessels, 58 

mechanism of, 58 

relation of prostate to, 73 

seat, 59 
Erector, 364 
Erectores penis, 63 
Ergotin, 326 
Eunuchs, 103 

Exercises in impotence, 358, 359 
External applications in impotence, 

356 



Faradic current, 347 

Fatigue, bodily, 254 

Favorite child, 163 

Fear, 248 

Fissures in corpora cavernosa, 1 13 

in glans, 100 

in prepuce, 100 
Flagellations, 361 
Flapping, 338, 339 
Flogging, onanism and, 215 
Follicular cells, Sertoli's, 65 



39 6 



INDEX 



Foods, impotence from, 147 

onanism and, 216 

virility and, 152 
Fowler's solution in spermatorrhea, 

Franklinization, 347 

Frauding, 75, 277 

Frenulum, excessive length, 100 

shortness, 100 
Freud's psycho-analysis, 297 
Friction, 339 
Frigidity, 162 

from excesses, 195 

from onanism, 220 

suspension for, 377 
Fuchsin solutions, 282, 354 
Fulguration, 384 



Galanga, 328 

Galvanic current in impotence, 345 
Galvanization in impotence, 347 
Gassen's compressors, 368 

erector, 364 

ultima, 369 
Generative glands, implantation of, 

382 
Genital organs, male, anatomy of, 

30 
Genitals, acquired defects, 103 

appearance, 87 

defects of, diagnosis, 265 

diseases of, virility and, 1 29 

external applications to, in im- 
potence, 356 

impotence from malformations, 

melancholia from operations on, 

.23 
pigmentation of, indications, 88 
sensitiveness, 87, 88 
sinapisms to, in impotence, 356 
tuberculosis of; 143 
vascularity, 88 
Gland, puberty, 107 
Glands, Cowper's, 43 

secretion of, and semen, 74 
internal secretion of, virility 
and, 145 
of Littre, 44 
testicular, 32 
Glandula prostatica, 38 



Glandular extracts, 379 
Glans, fissures in, 100 

penis, 46 
Golden-seal in pollutions, 314 
Goldschmidt's endoscopes, 384 

endourethral knives, 384 

urethroscope, 351 
Gonococcus in prostate, 133, 135 
Gonorrhea, prophylaxis of, 281 

prostatitis complicating, 134, 135 

silver nitrate in, 286 

treatment, 281 

damage to urethra in, 286 
virility and, 131, 138 
Gymnastics, 358 

for sexual power, 187 

in pollutions, 312 

sexual, 237 



Habit in pollutions, 231 

Half-baths, 341 

Health in pollutions, 234 

Heart diseases, impotence in, 117 

Heat, dry, for impotence, 343 

Helmithol, 385 

Henle's ampulla, 36 

Hercules, 369 

Heredity, impotence and, 158 

sexual power and, 89 
Hermaphrodites, 103 
Hernia, inguinal, impotence and, 

112 
Heroin, virility and, 157 
Herpes on prepuce, 130 
Hexamethylenamin, 385 
High-frequency treatment, 305, 

312, 348 
Homosexuality, diagnosis of, 173 
Hormones, virility and, 146 
Horseback riding, 359 
and onanism, 216 
Hydatis Morgagni, 35 
Hydrocele and impotence, 112 
Hydro-electric baths, 347, 348 
Hydrotherapy for impotence, 336 
Hygienic living for impotence, 

3i7 
Hyoscin for onanism, 308 
Hyperesthesia, bougies in, 354 
from onanism, 219 
of sexual sensations, 167 



INDEX 



397 



Hypertrophy of prostate, perver- 
sion and, 170 
surgical treatment, effect on 
sexual capacity, 386 

Hypnotism, 296 

Hypochondriac impotence, 246 

Hypospadia, 101 



Idiocy, impotence and, 176 
Idleness, onanism and, 216 
Implantation of generative glands, 

382 
Impotence, ablutions in, 339 

Abrams' concussion in, 362 

acquired deformities and, 91 

acupuncture in, 357 

adrenal extract in, 381 

amphotropin in, 385 

aphrodisiacs in, 322 

apparatus for, 362 

appearance in, 19, 20 

astringent injections in, 353 

atropin in, 326 

autocondensation in, 305, 390 

Azperger's rectal cooling sound 

in, 343 . 
balneological treatment, 342 
bathing in mineral waters in, 342 
baths in, 336 
bicycling in, 359 
blood-pressure in, 119 
bougies in, 354 
Brown-Sequard's liquor testicu- 

lorum in, 379 
brucin in, 326 
cantharides in, 323 
cantharidin in, 323 
capability of love in, 21 
carbon-douche in, 344 
carbonic-acid baths in, 344 
castoreum in, 327 
cinnamon in, 328 
circumcision in, 357 
classification, 92 
cocain in, 328 
cold water injected into urethra 

in, 343 
consecutive, 114 
damiana in, 329 
definition, 28 J 
diagnosis, 263 



Impotence, diathermy in, 384 
diet in, 317 

dilation of strictures for, 357 
douche-baths in, 339 
dreams and, 91 
dry cold in, 343 

warmth in, 343 
effects on body, 25 

on character, 20 

on mind, 19, 25 

on work, 19 
electricity in, 344 
electropuncture in, 357 
endoscopic examination in, 263 
epidural injections in, 357 
ergo tin in, 326 
etiology, 87 

age in, 89 
exercises in, 358, 359 
external applications in, 356 
faradic current in, 347 
flagellations in, 361 
flapping in, 338, 339 
following disease, diagnosis, 265 
forms, 96, 242 
franklinization in, 347 
frequency, 26 

Freud's psycho-analysis in, 297 
from acquired defects of genitalia, 

103 
from congenital malformations 

of genitalia, 96 
from continence, 241 

treatment, 390 
from distraction, 53 
from foods, 147 
from medicaments, 147 
from motorcar speeding, 359 
from occupation, treatment, 392 
from onanism, 221 
from poisons, 147 
fulguration in, 384 
galanga in, 328 
galvanic current in, 345 
galvanization in, 347 
Gassen's compressors in, 368 

cumulator in, 369 

erector in, 364 

ultima in, 369 
glandular extract in, 379 
gonorrhea and, 131 

as cause, prophylaxis, 281 



398 



INDEX 



Impotence, gymnastics in, 358 
half-baths in, 341 
helmithol in, 385 
hexamethylenamin in, 385 
high-frequency treatment, 305, 

312,348 
horseback riding in, 359 
hydro-electric baths in, 347, 348 
hydrotherapy for, 336 
hygienic living for, 317 
hypnotism in, 296 
hypochondriac, 246 
idiocy and, 176 
implantation of generative glands 

in, 382 _ 
in acute diseases, 114 
in chronic diseases, 116 
in insane, 121 
in wedlock, 252 
indian-hemp in, 327 
inhalations of oxygen in, 375 
inherited predisposition, 158 

diagnosis, 266 
instruments in, 362 
intravesical irrigations in, 354 
iron in, 326 

krameria triandra in, 354 
lake-bathing in, 342 
local treatment, 348 
love and, 21 

manner of living in, 320 
marriage and, 372 
massage in, 358, 360 

of testicles in, 360 
matrimony and, 21 
medicaments in, 321 
metal sounds in, 354, 355 
morphin in, 327 
muiracithin in, 335 
musk in, 327 
narcotics in, 327 
nervous diseases and, 120 
neurasthenic, 176 

diagnosis, 266 

prognosis, 269 

special therapeutics, 390 
nourishment in, 318 
nux vomica in, 325 
occupation and, 253 
oil of ants in, 324 
oil-beetles in, 324 
opium in, 327 



Impotence, organotherapy in, 379 
Oudin current in, 384 
paralytic, 181, 198, 242 

sexual nerves in, 201 

suspension in, 376 
phosphoric acid in, 325 
phosphorus in, 324 
pituitary extract in, 381 
Poehl's spermin in, 379 
professional, 253 
prognosis, 269 
prophylaxis, 272 
psychic, 91, 246 

ovarian extract in, 300 

spermin in, 299 
psychical treatment, 293 
psychotherapy in, 297 
psychrophor in, 342 
quinin in, 326 
rain baths in, 339 
relative, 250 

regulation of sexual life in, 370 
resection of dorsal vein of penis 

for, 357 m • 
river-bathing in, 341 
rubbing in, 339 
scincus marinus in, 328 
sea-bathing in, 341 
sea- voyages in, 361 
secale cornutum in, 326 
senile, 257 

treatment, 392 
sexual life and, 370 
shower-bath in, 339 
sinapisms in, 356 
sitz-bath in, 339 
sledge in, 363, 367, 369 
sleep in, 321 
special therapeutics, 383 
spices in, 328 ^ 
sponge-baths in, 339 
static electricity in, 33 
stimulants in, 328 
strychnin in, 325 
suicide from, 22 
sulphur waters in, 342 
surgical operations for, 357 
suspension in, 376 
Swedish movements in, 358 
temporary, 249 
thyroid extract in, 381 
tincture of nux vomica in, 356 



INDEX 



399 



Impotence, tincture of ratanhia in, 

354 
total, 29 
transmission of, 159 

traveling in, 361 

treatment, 291 
local, 348 
psychical, 293 

urethral suppositories in, 353 

urotropin in, 385 

valerian in, 328 

vanilla in, 328 

vapor-baths in, 341 

voyages in, 361 

Williams' penile splint in, 369, 
37o 

Winternitz's rectal cooling pouch 
in, 343 

yohimbin in, 329 
Incontinence of urine, sexual weak- 
ness and, 160 
Indian-hemp, 327 
Inguinal hernia and impotence, 112 
Inhalations of oxygen, 375 
Inhibition center, 56 
Injections, astringent, 353 

cold water, 343 
Insanity, impotence in, 121 
Instruments and apparatus, 362 
Internal secretion of glands, virility 

and, 145 
Interstitial cells of Leydig, 106 
Intravesical irrigations, 354 
Iodin, impotence and, 155 
Iron, 326 
Irritable weakness, 242 

special therapeutics, 391 
Isthmus urethrae, 43 



Kidneys, diseases of, impotence in, 

118 
Krafft-Ebing's schema of sexual 

neuroses, 92, 93 
Krameria triandra, 354 



Lacuna Morgagni, 44 
Lake-bathing, 342 
Lallemand's cauterization, 348 
Laudanum, tincture of, before in- 
tercourse, 153 



Lead-poisoning, virility and, 154 
Leydig's interstitial cells, 106 
Libido sexualis, 52 
Liquor testiculorum, 379 
Liquors, virility and, 150 
Littre's glands, 44 
Liver, diseases of, impotence in, 117 
Lobes of prostate, 39 
Love, excesses and, 185, 186 

impotence and, 21 
Love-potions, 321 
LupuHn, impotence and, 148, 155, 

156 
Lust-murder, 168 
Lymphatics of penis, 47, 49 



MacGo wan's urethroscope, 351 
Male genital organs, anatomy, 30 
Marriage, 372 

impotence and, 21 
Martin's operation for azoospermia, 

in 
Massage, 358, 360 

of prostate, 385 

of testicles, 360 
Masturbation, 205. See also Onan- 
ism. 
Matrimony, 372 

impotence and, 21 
Maturity, sexual, 50 
May- worms, 324 
McCarthy's urethroscope, 351 
Median raphe, 30 
Medicaments, impotence from, 147 

in impotence, 321 
Melancholia from operations on 

genitals, 23 
Meloes majales, 324 
Menstruation, coitin during, 277 

hypnotism for, 296 
Menthol, virility and, 156 
Mercury, virility and, 155 
Meyer's cauterizing instrument, 388 
Micturition and prostate, relation, 

133 
Milking of seminal vesicles, 371, 385 
Mind, effect of impotence on, 19, 25 

of onanism on, 207 
Mineral salts as aphrodisiacs, 336 
waters, bathing in, 342 
in pollutions, 311 



400 



INDEX 



Monobromated camphor, virility 
and, 156 

Monorchidia, 101, 102 

Morbid influences, removal, 295 
pollutions, classification, 223 

Morphin, 327 

virility and, 152, 153 

Motorcar speeding as cause of im- 
potence, 359 

Muira puama, 335 

Muiracithin, 335 

Murder, lust-, 168 

Musculi bulbocavernosi, 63 
ischiocavernosi, 63 

Museums cremaster, 31 

Musk, 327 

Myxedema, virility and, 147 



Narcotics, 327 

Natura frigida, 158 

Nephritic affections, impotence in, 

118 
Nerves of penis, 47 

of scrotum, 47 

of testicle, 47 

of vas deferens, 47 

sexual, in paralytic impotence, 
201 
Nervous diseases, impotence in, 120 
Nervousness, virility and, 163 
Neurasthenia, causes, 127 

definition, 124 

from excesses, 195 

from onanism, 218 

in children, 164 

mental work and, 128 

sexual, local diseases and, 139 

symptoms, 124 

virility and, 122, 163 
Neurasthenic impotence, 176 
diagnosis, 266 
prognosis, 269 
special therapeutics, 390 
Neuromuscular apparatus, action of 

testicular extracts on, 106 
Neuroses, disposition to, 163 

sexual, 92, 95 
Nicotin, virility and, 151 
Niter, impotence and, 155 
Nocturnal pollutions, 63 
spermatozoids in, 85 



Nux vomica, 325 
tincture, 356 



Obesity, capon-, 20 

excess and, 199 

impotence in, 118 
Obstipation, pollutions from, 228 
Occupation, impotence from treat- 
ment, 392 
CEdipus complex, 290 
Oil of ants, 324 
Oil-beetles, 324 
Onanism, 205 

antiquity, 210 

bad example and, 214 

causes, 210 

civilization and, 210 

coition and, 207 

consequences, 195, 217 

constipation inciting to, 215 

cutaneous diseases in, 217 

definition, 209 

diseases and, 217, 218 

effect on mind, 207 

excessive, 205 

fatality, 207 

flogging and, 215 

food and, 216 

forms, 208 

horseback riding and, 216 

hyoscin for, 308 

idleness and, 216 

impotence from, 221 

in children, 212 

lascivious reading and pictures 
and, 216 

mutual, 208, 209 

pollutions from, 220, 221, 229 

prophylaxis, 273 

reasons for pollutions from, 229 

sedentary life and, 215 

seduction and, 212 

spermatorrhea from, 221 

studies and, 213 

tight garments and, 217 

treatment, 273, 308 

uncleanliness and, 217 

universality, 211 

unwise parents and, 212 

working sewing-machines and, 
217 



INDEX 



401 



Only child, 163 

Opium, 327 
virility and, 152, 153 

Organotherapy, 379 

Orgasm, sexual, 52 

Ormcium externum urethrae, nar- 
rowness, 98 

Oudin current, 384 

Ovarian extract in psychic im- 
potence, 300 

Ovaries, internal secretion of, 107 

Ovary, transplantation of, in ani- 
mals, 107 

Oxaluria, impotence and, 117 

Oxygen, inhalations of, 375 



Painful ejaculation, 142 
Papillae, vascular, in urethra, 44 
Paralytic impotence, 181, 198, 242 
sexual nerves in, 201 
suspension in, 376 
Parenchyma of epididymis, 34 

of testicles, 34 
Pars cavernosa, 41, 43 

membranacea, 41, 43 
urethrae, 43 

prostatica, 41, 42 
Pederasty, 170 
Pendulous abdomen and impotence, 

117 
Penile splint, Williams', 369, 370 
Penis, absence of, 97 

amputation of, effect, 23 

anatomy, 41 

arteries of, 48 

blood-vessels of , 47 

curvature of, 98 

defective erectile tissue, 98 

dorsal vein, resection of, for 
impotence, 357 

excessive development, 98 

flabbiness, 98 

loss, 103 

lymphatics of, 47, 49 

nerves of , 47 

smallness, 97 

ulcers of, impotence from, 130 

veins of, 48 

wounds of, impotence from, 130 
Penis-bones, 114 
Perversion, 165 



Perversion, definition, 165 

for animals, 174 

for inanimate objects, 175 

for other sex, 168 

for own sex, 169 

prostatic hypertrophy and, 170 

treatment, 389 
Phenol, virility and, 156 
Philters, 321 
Phimosis, 99 
Phosphoric acid, 325 
Phosphorus, 324 
Phthisicus salax, 115 
Phthisis, sexual desire and, 115 
Physiologic pollutions, 222 
frequency, 222 

spermatorrhea, 68 
Pigmentation of genitals, indica- 
tions, 88 
Pituitary extract, 381 

gland, hormones of, virility and, 
146 
Plexus spermaticus seu pampini- 

formis, 35 
Poehl's spermin, 379, 380 
Poisoning, lead-, virility and, 154 
Poisons, impotence from, 147 
Pollutions, abnormal, 200 

advantages, 235 

alkaline waters in, 311 

antipyrin in, 313 

appearance in, 233 

atropin in, 313 

bromids in, 313 

camphor in, 313 

cocain in, 316 

cold applications in, 315 

cornutin in, 313 

definition, 224 

diagnosis, 231 

diurnal, 224 

during sleep, 223 

electricity in, 312 

enema in, 312 

Fowler's solution in, 313 

from diseases, 227, 228, 229 

from inflammations, 227 

from onanism, 220, 221, 229 

genitals in, 233 

golden seal in, 314 

gymnastics in, 312 

habit in, 231 



402 



INDEX 



Pollutions, health in, 234 

mineral waters in, 311 

morbid, classification, 223 

necessity, 235 

nocturnal, 63 

spermatozoids in, 85 

normal, 222 

partial bathing in, 315 

physiologic, 222 
frequency, 222 

predisposition to, 231 

secale cornutum in, 313 

semen of, 231 
endoscopic examination, 2^$ 

sodium nitrate in, 313 

treatment, 308 

vasectomy for, 316 

veratrum viride in, 313 
Position for coition, 276 
Potassium iodid and virility, 155 
Precipitate ejaculations, 243 

treatment, 391 
Prepuce, absence, 99 

adherent, 100 

anatomy of, 46 

excessive length, 99 

fissures in, 100 

herpes on, 130 

superfluity, 99 
Preputial calculus, 130 
Priapism from excesses, 204 
Procreation, duration, 52 
Professional impotence, 253 
Prognosis of impotence, 269 
Prophylaxis of gonorrhea, 281 

of impotence, 272 

of onanism, 273 
Prostate, anatomy, 38 

atrophy of, impotence in, 137 

bacteria in, 135, 136 

colon bacillus in, 137 

diseases of, virility and, 131 

functions, 132 

gonococcus in, 133, 134, 135 

hypertrophy of, perversion and, 
170 
surgical treatment, effect on 
sexual capacity, 386 

lobes of, 39 

massage of, 385 

micturition and, relation, 133 

nerves, 47 



Prostate, relation of, to erection, 73 
to semen, 72 

secretion, 41 
relation to semen, 133 

secretory nerve, 47 

surgical capsule of, 39 
Prostatectomy, effect on sexual 

capacity, 386 
Prostatitis, 133 

complicating gonorrhea, 133, 134 

impotence in, 137 

symptoms, 134 
Prostatorrhea from frauding, 280 
Prostitution, 374, 375 
Psychasthenia, 297 
Psychical impotence, 91, 246 
ovarian extract in, 300 
spermin in, 300 

treatment of impotence, 293 
Psycho-analysis, Freud's, 297 
Psychotherapy, 297 
Psychrophor, 342 
Puberty, 50 

gland, 107 



Quinin, 326 
virility and, 156 



Rain-baths, 339 

Raphe, median, 30 

Ratanhia, tincture, 354 

Rectal cooling pouch, Winternitz's, 

343 
sound, Azperger's, 343 
Recte ductus, 34, 35 
Relative impotence, 250 
Resection of dorsal vein of penis for 

impotence, 357 
Rest in impotence, 320, 321 
Rete vasculosum, 34 
Rheophore, bladder, 346 
Riding and onanism, 216 

sexual effect, 257 
River-bathing, 341 
Rubbing, 339 



Salicylic acid, virility and, 155 

Sarimbavy, 174 

Satiety for sexual pleasures, 196 



INDEX 



403 



Scholars, sexual feelings of, 255 
Scincus marinus, 328 
Scrotum, anatomy, 30 

nerves of, 47 
Sea-bathing, 341 

in spermatorrhea, 312 
Sea-voyages, 361 
Seasons, sexual desire and, 91 
Secale cornutum in impotence, 326 

in pollutions, 313 
Secretion, internal, of glands, vir- 
ility and, 145 
Secretory nerve of prostate, 47 
Sedentary life and onanism, 215 
Seduction and onanism, 212 
Semen, 64 
chemistry, 76 
crystals, 76 

microscopic appearance, 77 
nature, 70 
of pollutions, 75, 231 

endoscopic examination, 233 
of youths, spermatozoa in, 51 
old, effect on new semen, 70 
physical properties, 76 
quality, 74 

quantity ejaculated, 74, 75 
reabsorption, 66 
relation of prostate to, 72 

of prostatic secretion to, 133 
source, 64 
Seminal cord, anatomy, 73 
corpuscles, 65 
tubes, 34 
vesicles, 3s, 36 
functions, 71 
Senile impotence, 257 

treatment, 392 
Septum scroti, 32 
Sertoli's follicular cells, 65 
Sewing-machines, working, onan- 
ism and, 217 
Sexual act, physiology, 50 
capacity, 56 
bodily structure and, 88 
effect of surgical treatment of 
prostatic hypertrophy on, 
386 
heredity and, 89 
continence, effects, 236, 274 
desire, dreams and, 91 
in acute diseases, 114 



Sexual desire in chronic diseases, 116 
seasons and, 91 
diseases, prophylaxis, 281 
excess, 178 

reasons for, 184 
function, duration, 52 
gymnastics, 237 
instinct, cerebrum as seat, 62 
inhibition, 56 
seat, 56 
life, regulation, 370 
maturity, 50 
nerves in paralytic impotence, 

201 
neuroses, 92, 93 
organs, diseases of, virility and, 

129 
orgasm, 52 

perversion, 165. See also Perver- 
sion. 
power, abundance of, excesses 
and, 186 
abuse, 178 

antiquity, 181 
decrease in, 189 
profligacy, 385 
taste, changes in, 197 
vigor, diminished, cause, 157 

in old age, 260 
virility, 28 
weakness, 158 
incontinence of urine and, 160 
Shower-bath, 339 
Sidi's hypnoidal state, 296 
Silver nitrate in gonorrhea, 286 
Sinapisms, 356 
Sinus carnosa, 43 
isthmus, 43 
Morgagni, 43 
prostaticus, 43 
Sitz-bath, 339 
Skin-diseases, excesses and, 185 

onanism and, 217 
Skoptzi, 104 
Sledge, 363, 367, 369 
Sleep in impotence, 321 
Smell, sexual desire and, 119 
Smoking, virility and, 150 
Sneezing in coition, 120 
Snuff-taking, virility and, 151 
Sodium nitrate, impotence and, 156 
in pollutions, 313 



4Q4 



INDEX 



Sodomy, 174 

Sounds, metal, 354, 355 

urethral, dangers in use of, 287 
Sperm. See Semen. 
Spermatic canals, 33 

ears, 65 

spikes, 65 
Spermatides, 65 
Spermatoblasts, 64 
Spermatocytes, 65 
Spermatogoniums, 65 
Spermatorrhea, definition, 224 

diagnosisj 231 

excesses and, 200 

from onanism, 221 

physiologic, 68 

treatment, 308 
Spermatozoa, 66 

dead, 78 

death of, premature, 86 

effect of frequent coition on 
number, 79 

energy of movement, 85 

forward movement, 86 

head, 77 

in semen of youths, 51 

premature death, 86 

structure, 65, 66 

vitality, 78 
Spermatozoids, 65 
Spermin in psychic impotence, 
300 

Poehl's, 379, 380 
Sphincter vesicae externus, 38 

internus, 38 
Sphygmobiometer, 268 
Spices, 328 
Spinal cord, lesions of, impotence 

in, in 
Spirituous beverages in impotence, 

320 
Splint, Williams' penile, 369, 370 
Sponge-baths, 339 
Static electricity in impotence, 347 
Sterility, 257 

effect of young woman on, 261, 
262 
Stimulants as aphrodisiacs, 328 
Stricture, gradual dilation, for im- 
potence, 357 

of urethra, virility and, 138 
Strychnin, 325 



Suction-pump, 369 
Suicide from impotence, 22 
Sulphur waters, 342 
Suppositories, urethral, 353 
Suprarenal glands, virility and, 147 

preparations, virility and, 157 
Surgical capsule of prostate, 39 

operations for impotence, 357 
Suspension, 376 
Swedish movements, 358 
Swift-Ellis treatment, 358 
Swinburn's urethroscope, 351 



Tabes dorsalis from excesses, 203 
from onanism, 219 
impotence in, 121 
Tannin in alcohol, bathing with, in 

premature ejaculation, 392 
Tea, virility and, 150 
Temperament, 160 
Temporary impotence, 249 
Testicle, chief, 32 

one, absence of, 112 
Testicles, absence, 104 

anatomy, 30 

ascension, 31 

atrophy of, from excess, 202 
from onanism, 221 

descent of, defects in, 101 

hormones of, virility and, 146 

loss, 103, 104 

massage of, 360 

nerves of, 47 

parenchyma, 34 

position, 32 

shape, 32 

size, 32 

smallness, 97 

transplantation of, in animals, 
107 

tuberculosis of, virility and, 143 

undescended, 101 

volume, 32, 33 

weight, 32 
Testicular extracts, action of, on 
neuromuscular apparatus, 106 

gland, 32 
Therapeutics, special, 383 
Thermo-psychrophors, 344 
Thyroid extract, 381 

gland, virility and, 147 



INDEX 



405 



Thyroidine, virility and, 157 
Tobacco, virility and, 150, 151 
Transplantation of ovary in ani- 
mals, 107 

of testicles in animals, 107 
Traveling, 361 

Treatment of impotence, 291 
Tuberculosis of testicles, virility 
and, 143 

sexual desire and, 115 
Tunica albuginea, ^^ 

dartos, 31 

vaginalis communis, 31 
propria, 31 
Turnera aphrodisiaca, 329 

Ulcers of penis, impotence from, 
130 

Ultima, 369 

Uncleanhness, onanism and, 217 

Urethra, anatomy of, 41 
bulbus, 45 

cold water injected into, in im- 
potence, 343 
cystic disease of, virility and, 141 
damage to, in treatment of gonor- 
rhea, 286 
external orifice of, narrowness, 98 
stricture of, virility and, 138 

Urethral sound, dangers in use of, 
287 
suppositories, 353 

Urethritis chronica cystica, 139 

Urethroscopes, 351 

Urinary bladder, diseases of, virility 
and, 138 

Urine, incontinence of, sexual weak- 
ness and, 160 

Urnings, 169 

Urotropin, 385 

Ursamenzellen, 65 

Utriculus prostaticus, 43 



Valerian, 328 

Vanilla, 328 

Vanity, excesses and, 184 

Vapor-baths, 341 

Varicocele, virility and, 144 

Vas deferens, 34, 35 

nerves of, 47 

occlusion of, 317 



Vas epididymis, 35 
Vasa aberrantia, 35 

seminalia, ^ 
Vasectomy for pollutions, 316 
Vein, dorsal, of penis, resection, for 

impotence, 357 
Veins of penis, 48 
Venereal diseases, prophylaxis, 281 
Venery, excesses in, 178 
consequences, 193 
death from, 202 
definition, 179, 180 
effect of, on body, 198 
reasons for, 184 
satiety after, 196 
Ventouse, 363 

Veratrum viride in pollutions, 313 
Verumontanum, lesions of, virility 

and, 140 
Vesicula prostatica, 43 
Vesiculae seminales, function of, 71 

nerves of, 47 
Virility, conditions influencing, 87 
definition, 28 
importance, 18 
sexual, 28 
time, 90 
weakening of, from continence, 

. 2 3. 8 
Voice in puberty, 51 

Voluptuous women, excesses and, 

185 

Voyages, sea-, 361 



Warmth, dry, in impotence, 343 
Water, cold, injected into urethra, 

in impotence, 343 
Williams' penile splint, 369, 370 
Wine, impotence and, 149 
Winternitz cooling sound, 342 

rectal cooling pouch, 343 
Work, effect of impotence on, 19 

sexual power and, 254 
Wossidlo's endoscope, 140 

urethroscope, 351 
Wounds of penis, impotence from, 

130 



YOHIMBENIN, 329 

Yohimbin, 329 



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Dr. Eyre has subjected his work to a most searching revision. Indeed, 
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pages and 50 illustrations, had to be reset from cover to cover. He has in- 
cluded all the latest technic in every division of the subject. His thorough- 
ness, his accuracy, his attention to detail make his work an important one. 
He gives clearly the technic for the bacteriologic examination of water, sew- 
age, air, soil, milk and its products, meats, etc. 



Howell's Physiology 



A Text=Book of Physiology. By William H. Howell, 
Ph. D., M. D., Professor of Physiology in the Johns Hopkins 
University, Baltimore, Md. Octavo of 1020 pages, with 306 
illustrations. Cloth, $4.00 net. 

NEW (5th) EDITION 

Dr. Howell has had many years of experience as a teacher of physiology 
in several of the leading medical schools, and is therefore exceedingly well 
fitted to write a text-book on this subject. Main emphasis has been laid 
upon those facts and views which will be directly helpful in the practical 
branches of medicine. At the same time, however, sufficient consideration 
has been given to the experimental side of the science. 

The London Lancet 

" This is one of the best recent books on physiology, and we warmly commend it to the 
attention of those who desire to obtain by reading- a general all-round, yet concise survey of 
the scope, facts, theories, and speculations that make up its subject matter." 



SAUNDERS' BOOKS ON 



Jordan's General Bacteriology 

A Text=Book of General Bacteriology. By Edwin O. 
Jordan, Ph.D., Professor of Bacteriology in the University of 
Chicago and in Rush Medical College. Octavo of 623 pages, 
illustrated. Cloth, $3.00 net. 

THE NEW (4th) EDITION 

Professor Jordan's work embraces the entire field of bacteriology, the non- 
pathogenic as well as the pathogenic bacteria being considered, giving greater 
emphasis, of course, to the latter. There are extensive chapters on methods of 
studying bacteria, their development and composition ; on enzymes and 
fermentation-products ; on the bacterial production of pigment, acid and 
alkali ; and on ptomains and toxins. Especially complete is the presentation 
of serum treatment. 

This work will also appeal to academic and scientific students. It con- 
tains chapters on the bacteriology of plants, milk and milk-products, air, 
agriculture, water, food preservatives, the processes of leather tanning, 
tobacco curing, and vinegar making ; the relation of bacteriology to house- 
hold administration and to sanitary engineering, etc. 

Prof. Severance Bllirag'e, Associate Prof, of Sanitary Science, Purdue University. 

" I am much impressed with the completeness and accuracy of the book. It certainly 
covers the ground more completely than any other American book that I have seen." 



Buchanan's Veterinary Bacteriology 

Veterinary Bacteriology. By Robert E. Buchanan, 

Ph.D., Professor of Bacteriology in the Iowa State College of 

Agriculture and Mechanic Arts. Octavo of 5 1 6 pages, with 214 

illustrations. Cloth, $3.00 net. 

THE BEST PUBLISHED 

Professor Buchanan's new work is a comprehensive one. The author has 
gone minutely into the consideration of immunity, opsonic index, reproduc- 
tion, sterilization, antiseptics, biochemic tests, culture media, isolation of cul- 
tures, the manufacture of the various toxins, antitoxins, tuberculins, and vac- 
cines that have proved of diagnostic or therapeutic value. Then, in addition 
to bacteria and protozoa proper, he considers molds, mildews, smuts, rusts, 
toadstools, puff-balls, and the other fungi pathogenic for animals. 

B. F*. Kaupp, D. V. S., State Agricultural College, Fort Collins. 

" It is the best in print on the subject. What pieases me most is that it contains all 
the late results of research. It fills a long felt want." 



BACTERIOLOGY AND HISTOLOGY. 



McFarland's Pathogenic Bac 
teria and Protozoa 



Pathogenic Bacteria and Protozoa. By Joseph McFar- 
land, M. D., Professor of Pathology and Bacteriology in the 
Medico-Chirurgical College of Philadelphia. Octavo of 878 
pages, finely illustrated. Cloth, $3.50 net. 

NEW (7th) EDITION, ENLARGED 

Dr. McFarland has subjected his book to a most vigorous revision, bring- 
ing this edition right down to the minute. Important new additions have 
increased it in size some 180 pages. By far the most important addition is 
the inclusion of an entirely new section on Pathogenic Protozoa. This sec- 
tion considers every protozoan pathogenic to man ; and in that same clean-cut, 
definite way that won for McFarland' s work a place in the very front of 
medical bacteriologies. The illustrations are the best and are beautifully 
executed. 



mirs 

Histology and Organography 

A Manual of Histology and Organography. By Charles 
Hill, M. D., formerly Assistant Professor of Histology and Em- 
bryology, Northwestern University, Chicago. i2mo of 475 
pages, with 337 illustrations. Cloth, $2.25 net. 

NEW (3d) EDITION 

Pennsylvania Medical Journal 

•' It is arranged in such a manner as to be easy of access and comprehension. To any 
contemplating the study of histology and organography we would commend this work." 



SAUNDERS' BOOKS ON 



McFarland's Pathology 

A Text=Book of Pathology. By Joseph McFarland, M. D. , 
Professor of Pathology and Bacteriology in the Medico-Chirurg- 
ical College of Philadelphia. Octavo of 856 pages, with 437 
illustrations, many in colors. Cloth, $5.00 net; Half Morocco, 
$6.50 net. 

SECOND EDITION 

Dr. McFarland' s work was written to furnish a ready means of acquiring 
a thorough training in the subject, a training such as would be of daily help 
in your practice. For this edition every page has been gone over most care- 
fully, correcting, omitting the obsolete, and adding the new. Some sections 
have been entirely rewritten. 

St. Paul Medical Journal 

" It is safe to say that there are few who are better qualified to give a resume of the 
modern views on this subject than McFarland. The subject-matter is thoroughly up to 
date.'' 

Boston Medical and Surgical Journal 

" It contains a great mass of well-classified facts. One of the best sections is that on 
the special pathology of the blood." 



McFarland's Medical Biology 

Biology : Medical and General. By Joseph McFarland, 
M. D., Professor of Pathology and Bacteriology in the Medico- 
Chirurgical College of Philadelphia. Octavo of 45 7 pages, with 
160 illustrations. Cloth, $1.75 net. 

NEW (2d) EDITION 

All of the problems of medical science are in a sense biologic, and many 
of the problems of biology medical. This work is both a general and medical 
biology. The former because it discusses the peculiar nature and reactions of 
Living Substance generally; the latter because particular emphasis is laid on 
those subjects of special interest and value in the study and practice of medi- 
cine. 

Prof. W. R. McConnell, Pennsylvania State College. 

" It has some admirable features, the most valuable of which, it seems to me, is the 
careful resume of the subjects of heredity and evolution." 



PATHOLOGY. 



Stengel and Fox's Pathology 

Pathology. By Alfred Stengel, M. D., Sc. D., Professor 
of Medicine, University of Pennsylvania; and Herbert Fox, 
M. D., Director of the Pepper Laboratories of Clinical Medicine, 
University of Pennsylvania. Octavo of 1045 pages, with 468 
text-illustrations, many in colors, and 15 colored plates. Cloth, 
$6.00 net; Half Morocco, $7.50 net. 

JUST READY— NEW (6th) EDITION, REWRITTEN 

This new (6th) edition is virtually a new work. It has been rewritten 
throughout, reset in new type, and a larger type page used. New matter 
equivalent to 175 pages has been added and some 75 new illustrations, many 
of them in colors. In the first portions the sections on inflammation, retro- 
gressive processes, disorders of nutrition and metabolism, general etiology,- 
and diseases due to bacteria were wholly rewritten or very largely recast. A 
new section on transmissible diseases was added ; the terata were included, 
with a synoptical chapter on teratology. The glands of internal secretion 
were given a separate chapter, and new chapters on the pathology of eye, ear, 
and skin were added. 



Stiles' The Nervous System Just Out 

This new book is really a physiology and anatomy of the nervous system, 
emphasizing the means of conserving nervous energy. You get phys- 
iology, reflexes, anatomy, afferent nervous system, neuromuscular system 
and fatigue, autonomic system, the cerebrum and human development, 
emotion, sleep, dreams, neurasthenia, hygiene. 

i2mo of 230 pages, illustrated. By Percy Goldthwait Stiles, Instructor in 
Physiology at Harvard University. Cloth, $1.25 net. 

Stiles' Nutritional Physiology 

Professor Stiles' work opens with a brief but adequate presentation of 
the physiology of free-living cells and leads up to the more complex 
function in man. It takes up each organ, each secretion concerned with 
the process of digestion, discussing the part each plays in the physiology 
of nutrition — in the transformation of energy. 
i2mo of 275 pages, illustrated. By Percy Goldthwait Stiles. Cloth, $1.25 net. 



SAUNDERS' BOOKS ON 



Mallory arid Wright's 
Pathologic Technique 

Pathologic Technique. A Practical Manual for Workers in 
Pathologic Histology, including Directions for the Performance 
of Autopsies and for Clinical Diagnosis by Laboratory Methods, 
By Frank B. Mallory, M. D., Associate Professor of Pathology, 
Harvard University; and James H. Wright, M. D., Director of 
the Clinico-Pathologic Laboratories, Massachusetts General Hos- 
pital. Octavo of 500 pages, with 152 illustrations. Cloth,$3.oonet. 

FIFTH EDITION 

In revising the book for the new edition the authors have kept in view the 
needs of the laboratory worker, whether student, practitioner, or pathologist, 
for a practical manual of histologic and bacteriologic methods in the study of 
pathologic material. 

William H. Welch, M.D., 

Professor of Pathology, Johns Hopkins University, Baltimore, Md. 
" 1 have been looking forward to the publication of this book, and I am glad to say that 
I find it a most useful laboratory and post-mortem guide, full of practical information." 



Prentiss' Embryology 

Text=Book of Embryology. By Charles W. Prentiss, 
Ph. D., Professor of Microscopic Anatomy, Northwestern Uni- 
versity Medical School, Chicago. Quarto volume of 400 pages, 
with 400 illustrations, many of them in colors. Cloth, $3. 75 net. 

JUST ISSUED 

Dr. Prentiss' work fulfils a double purpose : It is a complete laboratory- 
manual with full directions for dissections and study, and it is as well a clearly- 
presented text on embryology. It is, of course, particularly adapted for the 
student's use, but recognizing the light that embryology throws on gross anat- 
omy and the importance of this knowledge both in surgery and general medi- 
cine, every opportunity has been taken to make this book of equal value and 
help to the man in active practice. From its careful study he can glean many 
points that will help him in his diagnoses and consequently in his treatments. 
Many new ideas, new developments evolved in the laboratory by Dr. Prentiss 
himself are published here for the first time. There are nearly 400 illustrations 
throughout the text, many of them in colors. 



EMBRYOLOGY 



Heisler's Embryology 

A Text=Book of Embryology. By John C. Heisler, M.D., 
Professor of Anatomy in the Medico-Chirurgical College, Phila- 
delphia. Octavo volume of 435 pages, with 212 illustrations, 32 
of them in colors. Cloth, $3.00 net. 

THIRD EDITION 

The fact of embryology having acquired in recent years such great interest 
in connection with the teaching and with the proper comprehension of human 
anatomy, it is of first importance to the student of medicine that a concise and 
yet sufficiently full text-book upon the subject be available. Heisler' s Em- 
bryology has become a standard work. 

G. Carl Huber, M.D., Professor of 'Embryology \ Wistar Institute, University of Penn. 

" I find the second edition of 'A Text-Book of Embryology' by Dr. Heisler an improve- 
ment on the first. The figures added increase greatly the value of the work. I am again 
recommending it to our students." 



Bohm, Davidoff, and Huber's Histology 

A Text=Book of Human Histology. Including Microscopic 
Technic. By Dr. A. A. Bohm and Dr. M. Von Davidoff, of 
Munich, and G. Carl Huber, M. D., Professor of Embryology at 
the Wistar Institute, University of Pennsylvania. Octavo of 528 
pages, with 361 beautiful original illustrations. Flexible cloth, 

$3-5° net - 

SECOND EDITION, ENLARGED 

The work of Drs. Bohm and Davidoff is well known in the German edition, 
and has been considered one of the most practically useful books on the 
subject of Human Histology. This second edition has been in great part 
rewritten and very much enlarged by Dr. Huber, who has also added over 
one hundred original illustrations. Dr. Huber' s extensive additions have 
made the work the most complete students' text-book on Histology in existence. 

Boston Medical and Surgical Journal 

" Is unquestionably a text-book of the first rank, having been carefully 
written by thorough masters of the subject, and in certain directions it is much 
superior to any other histological manual.'' 



SAUNDERS' BOOKS ON 



Wells' Chemical Pathology 

Chemical Pathology. — Being a Discussion of General Path- 
ology from the Standpoint of the Chemical Processes Involved. 
By H. Gideon Wells, Ph. D., M. D., Assistant Professor of 
Pathology in the University of Chicago. Octavo of 6x6 pages. 
Cloth, $3.25 net. 

NEW (2d) EDITION 

Dr. Wells' work is written for the physician, for those engaged in research 
in pathology and physiologic chemistry, and for the medical student. In the 
introductory chapter are discussed the chemistry and physics of the animal 
cell, giving the essential facts of ionization, diffusion, osmotic pressure, etc., 
and the relation of these facts to cellular activities. 

Wm. H. Welch, M.D., Professor of Pathology, Johns Hopkins University. 

" The work fills a real need in the English literature of a very important subject, and I 
shall be glad to recommend it to my students." 



Lusk on Nutrition 

Elements of the Science of Nutrition. By Graham 
Lusk, Ph. D., Professor of Physiology at Cornell Medical School. 
Octavo volume of 402 pages. Cloth, $3.00 net. 

THE NEW (2d) EDITION 

Prof. Lusk presents the scientific foundations upon which rests our 
knowledge of nutrition and metabolism, both in health and in disease. There 
are special chapters on the metabolism of diabetes and fever and on purin 
metabolism. The work will also prove valuable to students of animal 
dietetics at agricultural stations. 

Lewellys F. Barker, M. D. 

Professor of the Principles and Practice of Medicine, Johns Hopkins University 

" I shall recommend it highly to my students. It is a comfort to have such a dis- 
cussion of the subject in English." 



PATHOLOGY, ETC. n 



GET A m £±«\ r> «* n THE NEW 

THE BEST iTIIieriC^ill STANDARD 

Illustrated Dictionary 

Just Out— The New (8th) Edition 



The American Illustrated Medical Dictionary. A new 

and complete dictionary of the terms used in Medicine, Surgery, 
Dentistry, Pharmacy, Chemistry, Veterinary Science, Nursing, 
and all kindred branches; with over ioo new and elaborate 
tables and many handsome illustrations. By W. A. Newman 
Dorland, M.D., Editor of "The American Pocket Medical 
Dictionary." Large octavo of 1 137 pages, bound in full flexible 
leather, $4.50 net; with thumb index, $5.00 net. 

A KEY TO MEDICAL LITERATURE 

Gives a Maximum Amount of Matter in a Minimum Space 

THIS EDITION DEFINES OVER 1500 NEW TERMS 

This edition is not a makeshift revision. The editor and a corps of expert 
assistants have been working on it for two years. Result — a thoroughly 
down-to-the-minute dictionary, unequalled for completeness and usefulness by 
any other medical lexicon on the market. In it you get all the new words. 
This is important, because in dictionary service the new words are what you 
want. Then it has two-score other features that make it really a Medical 
Encyclopedia. 



PERSONAL OPINIONS 



Howard A. Kelly, M. D.. 

Professor of Gynecologic Surgery, fohns Hopkins University, Baltimore. 
"Dr. Dorland's dictionary is admirable. It is so well gotten up and of such conve- 
nient size. No errors have been found in my use of it." 

J. Collins Warren, M.D., 

Professor of Surgery, Harvard Medical School. 

"I regard it as a valuable aid to my medical literary work. It is very complete and 
of convenient size to handle comfortably. I use it in preference to any other." 



12 SAUNDERS' BOOKS ON 

Daug'herty's Economic Zoology 

Economic Zoology. By L. S. Daugherty, M.S., Ph. D., 
Professor of Zoology, State Normal School, Kirksville, Mo., 
and M. C. Daugherty, author with Jackson of "Agriculture 
Through the Laboratory and School Garden ' ' : Part I — Field 
and Laboratory Guide. i2mo of 275 pages, interleaved. 
Cloth, $1.25 net. Part II — Principles. i2mo of 406 pages, 
illustrated. Cloth, $2.00 net. 

ILLUSTRATED 

There is no other book just like this. Not only does it give the salient 
facts of structural zoology and the development of the various branches of ani- 
mals, but also the natural history — the life and habits — thus showing the inter- 
relations of structure, habit, and environment. In a word, it gives the princi- 
ples of zoology and their actual application, emphaizng the economic phase in 
every branch. 

Drew's Invertebrate Zoology edition 

A Laboratory Manual of Invertebrate Zoology. By Gil- 
man A. Drew, Ph. D., Assistant Director of the Marine Biological 
Laboratory. With the aid of former and present Members of the 
Zoological Staff of Instructors at the Marine Biological Laboratory, 
Woods Hole, Mass. nmo of 213 pages. Cloth, $1.25 net. 

McConnell's Pathology iomSS 

A Manual of Pathology. By Guthrie McConnell, M. D., 
Professor of Bacteriology and Pathology at Temple University, 
Philadelphia. i2mo of 523 pages, with 170 illustrations. Flexible 
leather, $2.50 net. 

" The book treats the subject of pathology with a thoroughness lacking in many 
works of greater pretension. The illustrations — many of them original — are profuse 
and of exceptional excellence." — New York State Journal^/ Medicine. 

Norm* Cardiac Pathology 

Studies in Cardiac Pathology. By George W. Norris, M. D., 
University of Pennsylvania. Large octavo of 235 pages, with 85 
illustrations. Cloth, $5.00 net. 

Hektoen and Riesman's Pathology 

American Text-Book of Pathology. Edited by Ludvig Hek- 
toen, M. D., and David Riesman, M. D. Octavo of 1245 pages, 443 
illustrations, 66 in colors. Cloth, $7.50 net; Half Morocco, $9.00 net. 



HISTOLOGY. 



■3 



Dtirck and Hektoen's 
Special Pathologic Histology 

Atlas and Epitome of Special Pathologic Histology. 

By Dr. H. Durck, of Munich. Edited, with additions, by 
Ludvig Hektoen, M. D., Professor of Pathology, Rush Medical 
College, Chicago. In two parts. Part I. — Circulatory, Respira- 
tory, and Gastro-intestinal Tracts. 120 colored figures on 62 
plates, and 158 pages of text. Part II. — Liver, Urinary and 
Sexual Organs, Nervous System, Skin, Muscles, and Bones. 123 
colored figures on 60 plates, and 192 pages of text. Per part : 
Cloth, $3.00 net. /// Saunders' Ha?id- Atlas Series. 

The great value of these plates is that they represent in the exact colors 
the effect of the stains, which is of such great importance for the differentia- 
tion of tissue. The text portion of the book is admirable. 

William H. Welch, M. D., 

Professor of Pathology, Johns Hopkins University, Baltimore. 

" I consider Diirck's 'Atlas of Special Pathologic Histology,' edited by Hektoen, a very 
useful book for students and others. The plates are admirable." 

Sobotta and Huber's 
Human Histology 

Atlas and Epitome of Human Histology and Microscopic 
Anatomy. By Privatdocent Dr. J. Sobotta, of Wiirzburg. 
Edited, with additions, by G. Carl Huber, M. D. , Professor of 

Histology and Embryology, and Director of the Histological 
Laboratory, University of Michigan, Ann Arbor. With 214 
colored figures on 80 plates, 68 text-illustrations, and 248 pages 
of text. Cloth, $4.50 net. In Saunders' Hand-Atlas Series. 

Lewellys F. Barker, M. D., 

Professor of the Principles and Practice of Medicine, Joh?is Hopkins University. 

"I congratulate you upon the appearance of this volume. The illustrations are 
certainly very fine, and Dr. Huber has made important contributions to the text. The 
book should have a large sale." 



14 SAUNDERS' BOOKS ON 

Bosanquet on Spirochaetes 

Spirochaetes. By W. Cecil Bosanquet, M. D., Fellow 
Royal College of Physicians, London. Octavo, 152 pages, illus- 
trated. $2.50 net. 

ILLUSTRATED 

This is a complete and authoritative monograph on the spirochaetes, giving 
morphology, pathogenesis, classification, staining, etc. Pseudospirochietes are 
also considered, and the entire text well illustrated. The high standing of Dr. 
Bosanquet in this field of study makes this new work particularly valuable. 



Levy and Klemperer's 
Clinical Bacteriology 

The Elements of Clinical Bacteriology. By Drs. Ernst 
Levy and Felix Klemperer, of the University of Strasburg 
Translated and edited by Augustus A. Eshner, M. D., Pro- 
fessor of Clinical Medicine, Philadelphia Polyclinic. Octavo 
volume of 440 pages, fully illustrated. Cloth, $2.50 net. 



Lehmann, Neumann, and 
Weaver's Bacteriolog'y 

Atlas and Epitome of Bacteriology : including a Text- 
Book of Special Bacteriologic Diagnosis. By Prof. Dr. 
K. B. Lehmann and Dr. R. O. Neumann, of Wtirzburg. From 
the Seco7id Revised and Enlarged German Edition. Edited, 
with additions, by G. H. Weaver, M. D., Assistant Professor 
of Pathology and Bacteriology, Rush Medical College, Chicago. 
In two parts. Part I. — 632 colored figures on 69 lithographic 
plates. Part II. — 511 pages of text, illustrated. Per part: 
Cloth, $2.50 net. In Saunders' Hand-Atlas Series. 



PATHOLOGY, BACTERIOLOGY, AND PHYSIOLOGY. 15 

Durck and Hektoen's General Pathologic Histology 

Atlas and Epitome of General Pathologic Histology. By- 
PR. Dr. H. Durck, of Munich. Edited, with additions, by Ludvig 
Hektoen, M. D., Professor of Pathology in Rush Medical College, 
Chicago. 172 colored figures on 77 lithographic plates, 36 text-cuts^ 
many in colors, and 353 pages. Cloth, #5.00 net. In Saunders' Hand- 
Atlas Series. 

American Text- Book of Physiology Second Edition 

American Text-Book of Physiology. In two volumes. Edited 
by William H. Howell, Ph. D., M. D., Professor of Physiology in 
the Johns Hopkins University, Baltimore, Md. Two royal octavos of 
about 600 pages each, illustrated. Per volume : Cloth, $3.00 net; Half 
Morocco, $4.25 net. 

" The work will stand as a work of reference on physiology. To him who desires 
to know the status of modern physiology, who expects to obtain suggestions as to 
further physiologic inquiry, we know of none in English which so eminently meets 
such a demand " — The Medical News. 

Warren's Pathology and Therapeutics Edition 

Surgical Pathology and Therapeutics. By John Collins 
Warren, M. D., LL. D., F. R. C. S. (Hon.), Professor of Surgery, 
Harvard Medical School. Octavo, 873 pages, 136 half-tone and litho- 
graphic illustrations, 2>2> ^ n colors. Cloth, $5.00 net; Half Morocco, 
$6. 50 net. 

Raymond's Physiology Third Edition 

Human Physiology. By Joseph H. Raymond, M. D., formerly. 
Professor of Physiology and Hygiene, Long Island College Hospital, New 
York. Octavo of 685 pages, 444 illustrations. Cloth, #3.50 net. 

"The hook is well gotten up and well printed, and may be regarded as a trust- 
worthy guide for the student and a useful work of reference for the general practi- 
tioner. The illustrations are numerous and are well executed."— The Lancet, London- 



i u 

16 BACTERIOLOGY, PHYSIOLOGY, AND HISTOLOGY. 



. ^ I sL 

Ball'S Bacteriology Seventh Edition, Revised 

Essentials of Bacteriology : being a concise and systematic intro- 
duction to the Study of Micro-organisms. By M. V. Ball, M. D., late 
Bacteriologist to St. Agnes' Hospital, Philadelphia. i2mo of 289 pages, 
with 135 illustrations, some in colors. Cloth, $1.00 net. In Saunders'' 
Question- Compend Series. 

" The technic with regard to media, staining, mounting, and the like is culled from 
the latest authoritative works/'— The Medical Times, New York. 

Budgetfs Physiology Third Edition 

Essentials of Physiology. Prepared especially for Students of 
Medicine, and arranged with questions following each chapter. By 
Sidney P. Budgett, M. D., formerly Professor of Physiology, Washing- 
ton University, St. Louis. Revised by Havan Emerson, M. D., Demon- 
strator of Physiology, Columbia University. i2mo volume of 250 pages, 
illustrated. Cloth, $1.00 net. Saunders' Question- Compend Series. 

"He has an excellent conception of his subject ... It is one of the most satisfac- 
tory books of this class. — U'liversity of Pennsylvania Medical Bulletin. 

Leroy's Histology Fourth Edition 

Essentials of Histology, By Louis Leroy, M. D., Professor of 
Histology and Pathology, Vanderbilt University, Nashville, Tennessee. 
l2mo, 263 pages, with 92 original illustrations. Cloth 5 $i.co net. In 
Saunders' Question- Compend Series. 

" The work in its present form stands as a model of what a student's aid should be ; 
and we unhesitatingly say that the practitioner as well would find a glance through 
the book of lasting benefit," — The Medical World, Philadelphia. 

Barton and Wells' Medical Thesaurus 

A Thesaurus of Medical Words and Phrases. By Wilfred M. 
Barton, M. D., Assistant Professor of Materia Medica and Therapeu- 
tics ; and Walter A. Wells, M. D., Demonstrator of Laryngology, 
Georgetown University, Washington, D. C. l2mo, 534 pages. Flexible 
leather, $2.50 net. 

American Pocket Dictionary New (9th) Edition 

American Pocket Medical Dictionary. Edited by W. A. New- 
man Dorland, M. D. Containing the pronunciation and definition of 
the principal words used in medicine and kindred sciences, with 64 
extensive tables. Containing 693 pages. Flexible leather, with gold 
edges, $1.00 net; with patent thumb index, $1.25 net. 

" I can recommend it to our students without reserve." — J. H. Holland, M.D., 
qf the lefferson Medical College, Philadelphia. 



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